Enlarged papilla behind the upper incisors. Gingivitis

DISEASES OF THE MUCOSA OF THE ORAL CAVITY

According to their manifestations, diseases of the mucous membranes of the oral cavity can basically be divided into three groups: 1) inflammatory lesions- stomatitis; 2) lesions similar to a number of dermatoses, dermatostomatitis, or stomatosis; 3) diseases of a tumor nature. Recognition of all these diseases requires, first of all, knowledge of the normal anatomy and physiology of the oral mucosa, the ability to investigate it, taking into account the state of the whole organism, directly connected in its existence with the external environment.

RESEARCH METHODS. GENERAL SYMPTOMATOLOGY

The structure of the oral mucosa. The mucous membrane of the oral cavity consists of three layers: 1) epithelium (epithelium); 2) proper mucous membrane (mucosa propria); 3) submucosa (submucosa).

epithelial layer formed by stratified squamous epithelium. Cells in the epithelial layer various shapes- from a cylindrical, cubic layer to a completely squamous epithelium surfaces. As in the skin, the epithelial cover can be subdivided depending on the characteristics and function of its individual rows into four layers: 1) horny (stratum corneum), 2) transparent (stratum lucidum), 3) granular (stratum granulosum), 4) germinative (srtatum germinativum).

The germinal layer makes up a significant part of the mucosal epithelium. Its lower row consists of cylindrical, densely stained cells, with their narrow side facing their own shell. These cells are considered as the germinal layer of the germinal layer. This is followed by several rows of flatter cells, which are also well painted over and connected to each other by jumpers. Then come the layers of cells that are in various stages of keratinization: 1) the granular layer - the initial degree of keratinization, 2) the transparent layer - a more pronounced degree of keratinization, which is the transition to the last, clearly marked stratum corneum. The transparent layer of the epithelium on the oral mucosa is predominantly observed in those places where keratinization manifests itself with greater intensity.

Actually mucous membrane formed by dense connective tissue with a fibrillar structure. IN connective tissue the shell itself contains small blood vessels such as capillaries and nerves. The membrane on the border with the epithelium forms papillary outgrowths. These papillae are of various sizes. Each papilla has its own feeding vessel.

submucosa also of a connective tissue structure, but it is looser than the shell itself, and contains fat and glands; it contains larger vascular and nerve branches.

The mucous membrane of the oral cavity is supplied with nerve fibers - sensory and motor. The innervation of the mouth involves the cranial and spinal nerves, and cervical region sympathetic nerve. Of the cranial nerves, the following are suitable for the walls of the oral cavity: trigeminal, facial, glossopharyngeal, hypoglossal, partly vagus.

To study the oral mucosa, we use a number of techniques, which, depending on the characteristics of the case, are used in various numbers and combinations. The main examination of the oral cavity is made up of the following points: 1) - survey, 2) examination, 3) palpation - palpation, 4) microscopic studies. In addition, a study of the general condition of the body and individual systems and organs is carried out, and often additional serological, hematological and other lab tests.

Onpos. As always, in case of diseases of the mouth, general, indicative questions are first asked, and then questions of a particular nature. When questioning patients suffering from lesions of the mouth, the doctor often immediately detects a number of objective symptoms that are associated with a disorder in the act of speech (dyslalia). They appear as a result of damage to the tissues of the mouth by processes inflammatory nature or the presence of congenital or acquired defects of the oral cavity. Disorders are manifested in a change in the sonority of speech and the nature of the pronunciation of individual sounds - letters.

Inflammatory processes on the lips, which reduce the mobility or swelling of the latter due to pain, often distort the pronunciation of most of the labial sounds: “m”, “f”, “b”, “p”, “c” (dyslalia labialis).

Inflammatory processes in the tongue, especially peptic ulcers or other diseases leading to restriction of the mobility of this organ, make it difficult to pronounce almost all consonants, which leads to a lisping conversation (dyslalia labialis). When defeated back section language, the pronunciation of the sounds "g" and "k" is especially affected.

In case of integrity violations hard palate(syphilis, congenital fissure defects, injuries) and with damage to the soft palate, even a slight one, speech takes on a nasal tone: all consonants are pronounced nose. The pronunciation of the so-called closed consonants is especially disturbed: “p”, “b”, “t”, “d”, “s”. This speech disorder is called rhinolalia aperta as opposed to rhinolalia clausa (muffled sound). The last disorder is observed with infiltrating processes of the palatine sail.

The doctor draws attention to all these disorders already at the beginning of the conversation with the patient, thus introducing elements functional research mouth.

Of particular note are complaints of difficulty and soreness during meals, mainly with damage to the soft palate. Swelling of the palate and soreness interfere with the normal act of active swallowing. If the integrity of the palatine vault is violated, liquid food flows into the nose. Small abrasions on the hard palate often cause severe pain when eating solid food. Painful lesions tongue also cause difficulty in taking solid food, liquid food passes more easily. Complaints about painful eating can also occur with damage to the vestibule of the oral cavity. With stomatitis, ulcerative processes in the mouth, patients complain of bad breath (foetor ex ore).

It is important to establish the relationship of mucosal lesions with some other diseases. In the presence of stomatitis and stomatosis, it is necessary to contact Special attention on common infectious diseases, diseases of the digestive system, metabolism.

In acute cases, it is important to determine the presence of some acute general infection, such as influenza. Often, influenza infection may precede stomatitis. In some acute diseases, damage to the mucous membrane gives signs that are very valuable for diagnosis, for example, Filatov's spots in measles. Often stomatitis complicates some general debilitating illness or follows an illness, especially often after influenza. Acute as well as chronic mucosal lesions may be associated with skin diseases, general poisoning(medication, occupational, etc.), diseases gastrointestinal tract(anid and anacid gastritis, membranous colitis, etc.), helminthic invasion, malnutrition (avitaminosis - scurvy, pellagra, etc.), blood diseases (anemia, leukemia, etc.). Specific infections - tuberculosis and syphilis - should be highlighted. Diseases of the glands internal secretion such as dysfunction thyroid gland, should also be noted during the survey.

Examination of the oral mucosa. The most valuable method of examining the mouth is examination. Inspection should be subjected, regardless of the alleged diagnosis, all parts of the mouth. It is necessary to examine the mouth at a very good lighting, preferably daytime. Inspection is subject not only to the site of the lesion, but the entire mucous membrane of the oral cavity and the affected areas of the mucous membrane of the pharynx, skin, perioral region and face.

Lips and cheeks. The mucous membrane of the mouth mainly differs from the skin in the presence of a thin epithelial layer, very slight keratinization surface layers, abundant blood supply due to the presence of thick vasculature, absence of hair follicles and sweat glands, a small amount sebaceous glands, which are mainly located on the mucous membrane of the lips from the corners of the mouth to the free edge of the teeth. The skin, located at the site of transition to the mucous membrane in the region of the red border of the lips, also approaches the mucous membrane in its structure. These features of the latter, as well as the presence of bacteria and a moist warm environment in the form of oral fluid, cause a different manifestation of the same origin of lesions on the mucous membrane and skin.

Start the examination from the vestibule of the mouth. With a mirror, spatula or crochet, first the lip is pulled, then the cheek. On the inner surface of the lip, thin superficial veins shine through from under the mucous membrane and intertwining strands of loose connective tissue and the circular muscles of the mouth protrude. A closer examination reveals sparsely scattered small yellowish-white nodules. These are the sebaceous glands. In persons suffering from seborrhoea, the number of sebaceous glands in the oral cavity is often increased. On the lateral parts of the lips, especially the upper, small nodular protrusions are visible - mucous glands. On the mucous membrane of the cheeks, the sebaceous glands are sometimes found in significant numbers in the form of a scattering of yellowish-white or grayish tubercles, which are usually located along the bite line in the region of the molars and premolars. Meet on the mucous membrane of the cheeks and acinar glands. There are fewer of them here than on the lip, but they are larger in size. A particularly large gland is laid against the third upper molar (gianduia molaris). It should not be confused with pathological formation. In inflammatory processes of the mucous membrane, the number of visible glands usually increases.

On the buccal mucosa at the level of the second upper molar, if the cheek is pulled back, one can see a small protrusion of the papilla type, at the top of which the stenon duct opens - the excretory duct of the parotid gland. To determine the patency of the stenon duct, the examination can be supplemented with probing. The direction of the stenon duct in the thickness of the cheek is determined by a line drawn from the earlobe to the red border upper lip. Probing is performed using a thin blunt probe, while the cheek should be pulled outward as much as possible. The probe, however, cannot be passed into the gland. Usually the probe gets stuck in the place where the stenopathic duct passes through m. buccinator. Without extreme necessity, probing is not recommended to avoid the introduction of infection and injury. Is it easier and safer to examine the function of the gland by massage? massage the outside of the parotid gland; the doctor at the same time observes the opening of the duct; saliva flows normally. With inflammation of the gland or blockage of the duct, saliva is not secreted, but pus appears.

On the transitional fold, mainly at the point of transition of the buccal mucosa to the gum, in the region of the upper molars, blood vessels, especially veins, are sometimes sharply translucent. They should not be mistaken for pathological formations.

The normal mucous membrane of the lips and cheeks is mobile, especially on the lower lip; it is less mobile on the cheeks, where it is fixed by the fibers of the buccal muscle (m. buccinator). In the presence of inflammatory processes, deeply penetrating ulcers, the mucous membrane takes on an edematous, swollen appearance, teeth marks are sometimes visible on it, its mobility is sharply limited.

In addition to inflammatory processes, swelling of the mucous membrane is observed with cardiac and renal suffering, with some diseases associated with dysfunction of the endocrine glands (myxedema, acromegaly).

After examining the vestibule of the mouth (lips and cheeks), the oral cavity is examined (Fig. 175).

The mucous membrane of the hard palate in appearance it differs significantly from that on the cheeks. It is paler, denser, motionless and has a different relief. In the anterior part, symmetrical, transverse elevations of the mucous membrane (plicae palatinae transversae) are noted, which smooth out with age. The relief of the palate mucosa is significantly distorted under the influence of wearing plastic prostheses. In the midline at the central incisors is a pear-shaped elevation - palatine papilla (papilla palatina). In some subjects, it may be pronounced, but it should not be mistaken for a pathological formation. The region of the palatine papilla corresponds to the location of the incisive canal upper jaw(canalis incivus). Sometimes in the middle of the hard palate there is a rather sharply protruding longitudinally located elevation (torus palatinus). This formation is a thickening of the palatine suture (raphe palatini), it also cannot be considered pathological. In the thickness of the mucous membrane covering the sky, numerous glands are laid. They are located mainly in the mucosa of the posterior third of the hard palate, closer to the soft palate. excretory ducts these glands open in the form of pinholes - depressions on the mucous membrane of the palate (foveae palatinae, fossae eribrosae).

The glands located under the mucous membrane of the hard palate also extend to the soft palate. The mucosa of the palate rarely looks like a uniformly colored cover. In smokers, it is almost always inflamed and colored deep red. With lesions of the liver and biliary tract, the color of the soft palate sometimes takes on a yellowish tint, with heart defects - cyanotic.

Language. When examining the tongue, a very complex picture is revealed. Its surface has a villous appearance due to the presence of various papillae. Usually the back of the tongue is colored in pink color with a matte finish. However, the tongue is often furred or coated, most often grey-brown. Any raid must be regarded as pathological phenomenon. Sometimes the language normal condition may appear coated with a white coating, which depends on the length of the filiform papillae (papillae filiformes) scattered over its upper surface - the back and root. This plaque may disappear with age, and sometimes change during the day (in the morning to be more pronounced, by the middle of the day, after eating, less).

The tongue, as a rule, is coated in cases where, due to inflammatory processes and soreness in the oral cavity or other reasons, its normal mobility is disturbed or speech, chewing, swallowing is difficult, there is a disease of the stomach, intestines. In such cases, plaque appears not only on the back and root of the tongue, but also on the tip and on the side surfaces. Plaque can also cover the palate and gums. Plaque, or deposit, is usually formed due to increased desquamation of the epithelium and mixing of desquamation products with bacteria, leukocytes, food debris and oral mucus. The presence of plaque on only one side of the tongue depends mostly on the limitation of the activity of this side of the tongue, which is observed with hemiplegia, neuralgia trigeminal nerve, hysterical anesthesia, unilateral localization of ulcers. IP Pavlov believes that the basis of the occurrence of raids is the neuroreflex mechanism.

Behind the angle formed by large papillae, at the top of which there is a blind opening (foramen coecum), the posterior part of the tongue, devoid of papillae, begins. The follicular apparatus of the tongue is laid here and, due to the presence of a large number of crypts (bays), this part resembles the tonsil in appearance. Some even call it "lingual tonsil". The follicular apparatus often increases with inflammatory processes in the oral cavity and pharynx. An increase can also be observed in the normal state of these departments, with changes in the lymphatic system of the body.

When examining the lateral surface of the tongue at its root, rather thick venous plexuses are visible, which sometimes may mistakenly appear to be abnormally enlarged (Fig. 176).

In the lower part of the tongue, the mucous membrane becomes more mobile in the middle, passes into the frenulum of the tongue and into the cover of the floor of the oral cavity on the sides. Two sublingual folds (plicae sublinguales) depart from the frenulum on both sides, under which the sublingual glands are located. Closer to the middle, lateral from the intersection of the sublingual fold and frenulum of the tongue, is the so-called sublingual meat (caruncula sublingualis), in which there are excretory openings of the sublingual and submandibular salivary glands. Inside from the sublingual fold, closer to the tip of the tongue, a thin, uneven, fringed process of the mucous membrane (plica fimbriata) is usually visible. In this fold there is an opening of the anterior lingual gland of Blandin-Nun (gl. Iingualis anterior), which is laid at the tip of the tongue or at the point of transition of the mucous membrane from the bottom to bottom surface language. With inflammatory processes that pass to the bottom of the oral cavity, the meat swells, rises, the mobility of the tongue is limited, and the tongue itself shifts upward.

Symptoms of inflammation. When examining the mucous membranes of the oral cavity, one should pay attention to a number of symptoms and take into account the degree and nature of their deviation from the normal appearance. The following features should be fixed first.

Firstly, type of mucous membrane: a) color, b) gloss, c) the nature of the surface.

Inflammatory processes cause a change in color a. At acute inflammation due to hyperemia, the mucosa takes on a bright pink color (gingivitis and stomatitis). The intensity of the color depends not only on the degree of overflow of the superficial vessels, but also on the tenderness of the mucous membrane. So, for example, on the lips, cheeks and soft palate the color is brighter than on the tongue and gums. At chronic inflammation(congestive hyperemia), the mucous membrane takes on a dark red color, a bluish tint, and a purple color.

Changes in the normal mucosal luster depend on the defeat of the epithelial cover: keratinization or violation of integrity (inflammatory and blastomatous processes), or the appearance of fibrinous or other layers (aphthae).

Surface nature may vary depending on changes in the level of the mucosa. According to the depth of destruction of the latter, one should distinguish: 1) abrasions (erosion) - violation of the integrity of the surface layer of the epithelium (there is no scar during healing); 2) excoriation - violation of the integrity of the papillary layer (during healing, a scar is formed); 3) ulcers - a violation of the integrity of all layers of the mucous membrane (during healing, deep scars are formed). Violation of the integrity of the mucosa in abrasions and ulcers causes changes in the level of the mucosa - lowering it. Scars, on the contrary, for the most part give a limited increase in the level on the mucosal surface. However, atrophic scars (with lupus) are known, causing a decrease in the level of the mucous membrane. A decrease is also observed with retracted scars after deep destruction of the mucous membrane.

Hypertrophic productive forms of mucosal inflammation also noticeably change its appearance.

Changes the relief of the surface of the mucous membranes and the presence of nodular and tubercular rashes. A nodule, or papule, is a small (from a pinhead to a pea) elevation of the mucous membrane in a limited area. The color of the mucous membrane above the papule is usually changed, since the basis of the papule is proliferation cellular elements in the papillary and subpapillary layers, accompanied by an expansion of superficial vessels. Papular rashes on the mucous membrane are observed mainly in inflammatory processes [syphilis, red lichen planus(lichen ruber planus)]. Large papules (plaques) are seen with aphthous stomatitis sometimes with syphilis.

tubercle in appearance it resembles a papule, differing from it only anatomically. It captures all layers of the mucous membrane. Due to this, the tubercle, unlike the papule, reverse development leaves a trace in the form of an atrophic scar. Typical manifestations of tuberculous lesions on the mucous membrane are lupus and tuberculous syphilis. The difference between the tuberculous eruptions in these two sufferings is that in syphilis the tubercle is sharply limited, while in lupus, on the contrary, the tubercle does not have a clear outline. Sometimes, as is the case, for example, with lupus, the presence of a tuberculous lesion of the mucous membrane is masked by secondary inflammatory phenomena. In this case, to identify tubercles, it is necessary to squeeze out blood from hyperemic tissue. This is achieved with the help of diascopy: a glass slide is pressed on the examined area of ​​the mucosa until it turns pale, then the lupus tubercle, if any, is indicated as a small yellowish-brown formation.

A gross change in the level of the surface of the mucous membrane is caused by the presence of neoplasms (tumors).

Thus, studying the appearance of the mucosa can be valuable for diagnosis. The definition of color, gloss, level should be supplemented by data on the extent of the lesion and the location of its elements.

Banal stomatitis and gingivitis usually give diffuse lesions, some specific gingivitis, such as lupus, are limited for the most part strictly localized in the area of ​​\u200b\u200bthe anterior upper teeth. Lupus erythematosus (lupus erythematodes) has a favorite localization on the oral mucosa - this is mainly the red border of the lips and inner surface cheeks in the region of the molars. Lichen planus is located mainly on the buccal mucosa, according to the bite line.

Further, it is necessary to distinguish a confluent lesion from a focal lesion, when the elements are located separately. In the oral cavity, the focal arrangement of the elements gives mainly syphilis. In tuberculous and banal inflammatory processes, a confluent arrangement of elements is observed. Almost always, when examining the oral cavity, the outer covers should also be examined.

Below is a diagram of the inspection.

Inspection scheme

1. Ascertaining damage to the mucous membrane.

2. The nature of the appearance and flow.

3. The main elements of the defeat.

4. Grouping elements

5. Growth of elements.

6. Stages of development of elements.

For the spot

1. Size.

3. Coloring.

4. Persistence.

5. Topography.

6. Flow.

7. The presence of other elements.

For papule and tubercle

1. Size.

3. Coloring.

4 stages of development.

5. Topography.

For an ulcer

1. Size.

5. Depth.

6. Secret.

7. Density.

8. Soreness.

9. Surrounding tissues

10. Development.

11. Current.

12. Topography.

For scars

1. Size.

4. Depth.

5. Coloring.

Having finished morphological analysis lesions, the doctor supplements it, if necessary, with a palpation examination, palpation. This cannot be neglected.

Examination of the external integument aims to establish mainly a change in the color and appearance of the skin, the presence of swelling. Such an examination usually does not give solid indicative signs, since the appearance of the swelling often says little about its nature and origin. Swelling of the cheeks and chin can be caused by the presence of collateral edema, which is very often caused by either phlegmonous inflammation of the subcutaneous tissue, or tumor process. To establish the nature of the swelling, it is necessary to "perform a palpation examination.

TO palpation examination lesions of the mouth have to be resorted to quite often. Palpation should be performed when examining neoplasms of the mouth, some ulcers, and in all cases of lesions of an unexplained nature.

When feeling the tumor, in addition to its consistency, one should determine the depth of the location, the mobility of the tumor itself and the mucous membrane above it, and the connection with the surrounding tissues and organs. When feeling the ulcer, the doctor should be interested in its density, edges and the nature of the infiltration around the ulcer. These data often provide valuable auxiliary information in the differential diagnosis between cancer, tuberculosis, syphilis, and nonspecific ulcers on the tongue, cheek, and lip.

A cancerous ulcer is characterized by the presence of a very dense cartilage in consistency, a rim around the ulceration. Feeling a cancerous ulcer is painless. On the contrary, palpation of a tuberculous ulcer often causes pain. The edges of the tuberculous ulcer are slightly compacted and do not give the sensation of a cartilaginous ring when palpated, which is so characteristic of cancer. Sometimes a hard chancre or a syphilitic ulcer on the lip or tongue, cheek, due to the presence of a dense, painless infiltrate, can be difficult to distinguish from a cancerous ulcer by touch.

Nonspecific ulcers of the oral mucosa, when palpated, are for the most part significantly different from those described above due to their superficial location. Here, however, one should keep in mind chronic ulcers of traumatic origin, especially those located on the lateral surface of the tongue, at its root. These ulcers, due to trauma constantly caused by a carious tooth or a poorly fitted prosthesis, are surrounded by a rather dense infiltrate. And yet they remain more superficial and less dense than in cancer.

Often, in order to examine dental patients, it is necessary to use palpation of the external tissues of the face and neck. This study is performed in search of inflammatory infiltrates, neoplasms, in the study of the lymphatic apparatus. Feeling the soft tissues of the face is recommended to be done with a well-fixed head.

Visible diffuse swelling of the soft tissues of the face, which is observed during inflammatory processes in the jaws, is mostly due to collateral edema. Palpation examination usually reveals the presence (or absence) of a compacted area, infiltrated tissue, or a fluctuating area of ​​​​an abscess in the test mass of edematous tissue.

The lymph nodes. Especially often it is necessary to make a study of the lymph nodes. As is known, the study of nodes has great importance For clinical evaluation inflammatory and blastomatous processes. Lymph from the soft and hard tissues of the mouth is drained through next system nodes. The first stage is the submandibular, mental, lingual and facial lymph nodes; the second is superficial and upper deep cervical nodes; the third is the lower deep cervical nodes. From the lower deep cervical nodes, lymph enters the truncus lymphaticus jugularis.

Separate areas of the mouth and dental system associated with the lymph nodes of the first stage as follows. All teeth, with the exception of the lower incisors, give lymph directly to the group of submandibular nodes, the lower incisors - to the mental and then to the submandibular nodes. The floor of the mouth, cheeks (directly and through the superficial facial nodes), as well as the lips are connected with the submandibular lymph nodes, with the exception of the middle part lower lip, giving lymph first to the chin nodes. Rear end gums mandible gives lymph to the submandibular nodes and deep cervical, and the front part - to the chin; gums of the upper jaw - only in the deep buccal, tongue - in the lingual and directly in the upper deep cervical. The sky is connected directly with the deep facial lymph nodes (Fig. 177, 178).

Palpation of the submental and submandibular lymph nodes is performed as follows. The doctor stands on the side and somewhat behind the patient. The patient relaxes the muscles of the neck, tilting his head slightly forward. With the tips of the three-middle fingers of both hands, the doctor penetrates the right and left into the submandibular region, pressing the soft tissues. The thumbs, while resting on the lower jaw, fixing the head. The submandibular nodes are located medially from the edge of the lower jaw in the following order. Anterior submandibular salivary gland- two groups of lymph nodes: 1) in front of the external maxillary artery and 2) behind the artery; behind the salivary gland is the third group of submandibular lymph nodes. The chin nodes are located along the midline of the chin between the chin-hyoid muscles (Fig. 177).

To feel the facial lymph nodes, it is more convenient to use a two-handed examination: one hand fixes and gives the cheek with inside, the other feels the glands from the outside. Sometimes a two-handed examination is also useful when palpating the submandibular and submental lymph nodes, for example, in very obese subjects with inflammatory infiltration of soft tissues, etc. Facial lymph nodes are located mainly on the buccal muscle in the space between the masticatory and circular muscles of the mouth. The cervical nodes run along the internal jugular vein.

When feeling the lymph nodes, it is important to establish their size, consistency, mobility and soreness. Normally, lymph nodes are not palpable at all or are not clearly palpable. Acute inflammatory processes in the mouth cause an increase in the corresponding nodes; the lymph nodes at the same time become painful when palpated. In these cases, acute perilymphadenitis may also appear, the nodes are palpated with a continuous package. In banal chronic inflammatory processes, the nodes are usually enlarged, mobile and slightly painful. The glands are especially dense in cancer and syphilis, they can also be palpated in separate packages. With cancer in the further stages of its existence, there may be a restriction of the mobility of the nodes due to metastases. Chronic perilymphadenitis is considered characteristic of tuberculous lesions of the lymph nodes.

Inflammation of the gingival papillae and the gingival margin, occurring with periods of exacerbations and remissions. Chronic gingivitis is manifested by congestive hyperemia and swelling of the gum mucosa, bleeding, deformation (growth, atrophy) of the gums, bad breath. The diagnosis of chronic gingivitis is made by a periodontist based on the history and examination of the oral cavity. Treatment of chronic gingivitis includes professional oral hygiene, local treatment with antiseptics, taking anti-inflammatory, decongestants, immunocorrectors, physiotherapy, and, if indicated, removal of gum growths.

ICD-10

K05.1

General information

Chronic gingivitis - long-term, mild inflammatory process in the superficial tissues of the gums. With gingivitis, the strength of the periodontal ligaments is not impaired, but in the case of a chronic course, pathological changes can progress to periodontal disease and be accompanied by tooth loss. Chronic gingivitis is the most common periodontal disease in dentistry, including in adolescents and young age. After 60 years, the incidence of chronic gingivitis reaches 90-100%. Women get chronic gingivitis less often than men.

Causes of chronic gingivitis

The leading factor in the development of chronic gingivitis is the facultative microflora that accumulates in dental deposits with insufficient oral care. In children, the risk of gum disease is increased due to the lack of proper hygiene, abundant accumulations of old plaque with unformed local immune defenses.

Chronic gingivitis may be associated with prolonged irritation of the gum tissue by tartar, the sharp edge of a decayed tooth, a hanging edge of a filling, artificial crowns, or orthodontic appliances. Thermal burns of the gums, exposure to acids, alkalis, ionizing radiation can lead to chronic gingivitis; intoxication with salts of heavy metals, medicines, smoking. The cause of chronic gingivitis can be anomalies and deformities of the dentoalveolar system ( mouth breathing, malocclusion, crowding of teeth, absence of antagonists).

To the occurrence of chronic gingivitis predisposes to a decrease in nonspecific resistance of the organism against the background of endocrine shifts(diabetes mellitus, puberty, pregnancy, menopause, taking COCs), pathologies of the digestive system, hypovitaminosis, systemic, allergic, skin and infectious diseases(tuberculosis, syphilis, actinomycosis). Desquamative gingivitis develops with systemic lupus erythematosus, pemphigus vulgaris, lichen planus, or with an abnormal local immune response to certain substances in dental plaque. Hormonal imbalance in adolescence contributes to the development of chronic hypertrophic gingivitis.

Classification of chronic gingivitis

According to the etiology, chronic gingivitis is divided into infectious, traumatic, thermal, chemical, iatrogenic, hormonally determined, allergic. In terms of prevalence, chronic gingivitis can be localized (papillitis - inflammation of the interdental papilla and marginal gingivitis - inflammation of the free edge of the gums) and generalized (diffuse).

Chronic gingivitis can occur in mild form(with damage to the gingival papillae), moderate (with spread to the marginal gum) and severe (with the capture of the entire alveolar gum). According to the nature of the inflammatory process, catarrhal, hypertrophic and atrophic chronic gingivitis are distinguished, as well as special morphological types: plasmacytic (atypical allergic gingivostomatitis), desquamative and granulomatous.

Symptoms of chronic gingivitis

With desquamative gingivitis, there are edematous erythematous spots, serous-hemorrhagic vesicles, foci of easily exfoliating epithelium with exposure of bleeding and painful underlying tissue. The course is characterized by a cyclical course with a sharp sudden onset, a gradual fading of symptoms and a long (1-2 years) period of remission. In the case of granulomatous gingivitis, single or multi-focal patches of red or red and white up to 2 cm in size in the area of ​​interdental papillae, sometimes with the capture of other parts of the gums.

The long-term chronic course of gingivitis is accompanied by its transition to atrophic gingivitis, which is characterized by degenerative changes in the gingival papillae and gingival margin, thinning and decrease in gum volume, exposure of the necks of the teeth, an increase in their sensitivity to temperature and taste stimuli, and severe soreness of the gums.

Diagnosis of chronic gingivitis

The diagnosis of chronic gingivitis can be established by a dentist or periodontist according to the anamnesis, visual and instrumental examination of the oral cavity. During a dental examination, the condition of the teeth, the mucous membrane of the gingival papillae and the gingival margin, the type of bite, the presence of dental deposits, the condition of dentures, etc. are assessed.

Probing of the gingival sulcus reveals a positive symptom of bleeding, preservation of the integrity of the gingival junction, absence of a gingival pocket, immobility of the teeth. State bone tissue determined by dental x-ray data. To establish the cause of chronic gingivitis and assess the state of the body as a whole, consultations of other specialists are necessary: ​​endocrinologist, gastroenterologist, infectious disease specialist, dermatologist, allergist, rheumatologist.

Treatment of chronic gingivitis

Comprehensive treatment of chronic gingivitis involves the elimination etiological factor, impact on the pathological focus and the patient's body as a whole. The elimination of local irritating and traumatic factors for the gums includes the removal of dental plaque, the treatment of caries, the removal of decayed teeth, the correction of malocclusion, defects in filling and prosthetics, the correction and replacement of orthopedic and orthodontic structures, the plasticity of the frenulum of the lips and tongue, etc.

As part of the complex therapy of chronic gingivitis, professional oral hygiene is carried out, treatment of the mucous membrane with antiseptics (solution of hydrogen peroxide, chlorhexidine, miramistin), rinsing with decoctions of herbs (chamomile, oak bark, eucalyptus) after eating or brushing teeth, periodontal applications on the gums. In some cases, timely and thorough removal of local irritants contributes to the complete elimination of inflammatory phenomena.

In chronic gingivitis, it is possible to use decongestant and anti-inflammatory drugs, if necessary, antibiotics, immunocorrectors. Positive effect in the treatment of chronic gingivitis, gum massage, UV radiation, drug electrophoresis, laser therapy are given. With a severe degree of chronic hypertrophic gingivitis, diathermocoagulation or cryodestruction of growths is performed, according to indications - gingivectomy.

Forecast and prevention of chronic gingivitis

With timely and rational treatment of chronic catarrhal gingivitis, recovery occurs; without elimination of its causes, relapses are possible. Complete cure atrophic gingivitis is unattainable, it is only possible to stop the process of atrophy. The outcome of symptomatic gingivitis depends on the severity of the underlying disease. If left untreated, chronic gingivitis progresses to periodontitis and periodontal disease with the risk of tooth loss.

Prevention of chronic gingivitis consists in observing the rules of oral hygiene, regular visits to the dentist (1-2 times a year), sanitation of foci of chronic infection and treatment of general somatic pathology.

ICD-10 code

Painful sensations, bleeding and inflammation of the oral mucosa in adults can cause no less inconvenience than toothache. In addition to discomfort, such a condition without timely and proper treatment can lead to tooth loss, or even several. Why does severe and persistent inflammation occur? - Possibly as a result of trauma to the teeth or mucous membranes. If gum inflammation does not go away on its own, you need to visit a dentist. With the appearance of pathological changes in the condition of the gums, it is urgent to seek advice from a periodontist.

Why gums can become inflamed: an overview of the causes

The doctor finds out the causes of changes in the interdental papillae, gums and, based on the results of the examination, prescribes the necessary treatment. Very often, redness, swelling of the gums can be caused by improper care of the teeth and oral cavity. Immunity plays important role in the protection of the body, with its low level, even a minor injury can become the root cause of inflammation. Many factors can cause gum disease, for example:

1. trauma to the teeth and gums;
2. chronic diseases of the cardiovascular system, diabetes mellitus, diseases of the digestive tract;
3. the hereditary factor is directly related to the appearance of inflammatory processes in the body;
4. the presence of bad habits;
5. hormonal disorders;
6. improperly organized dental and oral care can create problems;
7. treatment of inflammation is also carried out if an unsuitable crown or poor-quality filling has been installed.

Toothpastes

1. clean the soft plaque formed during the day;
2. help reduce inflammation and swelling;
3. contribute to the elimination of tartar;
4. have a healing effect;
5. reduce bleeding and irritation.

Well proven such effective pastes, like: Forest balm, Paradontax, Lakalut asset, President. In addition to the use of pastes, gum massage with a soft toothbrush can be an excellent preventive measure. Prevention to eliminate gum disease is no less important than timely therapy.

Antibiotics

Antibiotic therapy is used in the most serious and advanced cases. When does severe inflammation- Serious intoxication of the body develops. Medications not only eliminate the signs of the disease, but also contribute to the restoration of the functions of all systems. Antibiotics should be agreed with the attending physician, who will select required dose medication and develop a treatment plan. Medicines are available in the form of tablets, capsules, rinse solutions.

Pharmaceutical rinses

For mouthwashes, effective antiseptics are prescribed, such as Miramistin and. The best pharmacy remedy for inflammation is Miramistin. It has a disinfecting and anti-inflammatory effect on diseased affected gums and periodontal gingival papillae. In some cases, rinsing with a solution of hydrogen peroxide is prescribed. It must be remembered that all drugs should be used only as prescribed by a doctor.

Folk recipes for inflammation and redness of the gums

Treatment at home involves the use of folk remedies that will help with gum disease. Gingivitis can be cured at home - prescription drugs traditional medicine can relieve swelling, and when the gums itch and ache, they will have a calming effect. natural preparations prepared in the form of decoctions for rinsing or infusions for internal use.

• Use calendula Birch buds, chamomile, celandine, sage.
• In addition to herbs for cooking medicines bee products are often used: perga, propolis, honey.
• When the gum becomes inflamed and very sore, the periodontal papillae swell - salt treatment can help.
• Treatment of inflamed gums with salt is carried out as follows: add one teaspoon of salt to a glass of water at room temperature, mix well. Rinsing with this solution helps well when the gums, gum pocket and periodontal papillae are slightly reddened.

Despite the fact that all remedies are natural, some herbs contain toxic substances in varying proportions. Treatment with folk remedies should be carried out under the strict supervision of a physician.

Principles of treatment for diseases of the oral cavity

Self-medication in the event of the appearance of inflammatory processes in the oral cavity may not be effective. All specific appointments can only be carried out by a specialist who will eliminate the symptoms and help get rid of the cause of the disease. The doctor, if necessary, will prescribe an examination and laboratory tests. Redness, swelling of the gums and interdental perigingival papillae are signs of gingivitis. Prevention of inflammation of the upper and lower gums always gives good results, so do not forget about it.

Gingivitis

In the case when the mucous membrane has become inflamed, pus has formed in the gum pockets - there is a suspicion of gingivitis. In case of gingivitis, soft plaque is cleaned and hard dental deposits are removed using ultrasound. After that, it is assigned complex treatment aimed at reducing tissue edema, eliminating bleeding and getting rid of pain. When gingivitis develops, the gum becomes inflamed and swollen (only the surface layers of tissues are affected) - the treatment prognosis is positive, with strict adherence to the recommendations of a specialist.

Periodontitis

Periodontitis is a more serious form of the disease. With a long pathological process, the gingival periodontal papillae can atrophy along with the mucosal area. Periodontitis therapy is carried out according to the following plan:

Dental manipulations

In the event that a cyst or fistula has formed in the gum tissue, surgical intervention may be required. After anesthesia, the surgeon makes an incision, removes the affected fragment of the periosteum and removes pus from the resulting cavity. Then the wound is washed and a temporary drain is installed.

When restoring the dentition in the event that the gingival periodontal papillae have partially atrophied, they resort to surgical intervention. The specialist forms the gingival periodontal papillae using implants followed by a course of phonophoresis.

Wisdom tooth eruption

Sometimes inflammation develops due to the eruption of a wisdom tooth. The symptoms are: severe redness and inflammation, the gums hurt and ache, there is tissue swelling at the end of the dentition. Based on the x-ray examination, the specialist makes a decision either to remove the tooth or to prescribe conservative treatment.

In case of inflammation, rinses are prescribed antiseptic solutions, and in order to eliminate pain - drugs based on analgesics are used.

How to quickly relieve inflammation?

In order to quickly eliminate soreness and inflammation of the gums, you can use a solution of salt with soda for rinsing. Red mountain ash juice has excellent healing properties. Decoctions prepared from herbs are good for gum disease. Two tablespoons of dried raw materials are taken into a glass of boiling water, after which the broth must be allowed to brew for ten minutes. Optimum temperature rinse solution at about 35-40 degrees.

Papillitis is an inflammation limited to one or two, rarely more than the gingival papillae. Often, a single gingival polyp in appearance resembles a neoplasm, epulid. In some cases, there is a relatively rapid development of papillitis, which in a short time reaches the size of a cherry stone and more.

The disease in children, as in adults, occurs mainly from local irritants. In the absence of contact between adjacent teeth, the tooth gap
filled with food debris, which, during chewing, damage the gingival papilla, are pressed into the gingival pocket, and are sources of infection and inflammation of it. The presence of a sharp edge of a carious tooth that injures the gums during the act of chewing leads to the development of papillitis. Papillitis can also develop under the influence of the cauterizing effect of certain drugs, such as carbolic acid, arsenic acid and other strong acids that fall on the gum during dental treatment. One of the main causes of papillitis is an unsatisfactory filling of the proximal cavity, hanging on the gingival papilla and constantly injuring it in cases where the proximal fillings do not restore the contact point.

Papillitis also occurs under the influence of endogenous factors, in particular in violation of endocrine system, metabolism, cardiovascular and other systems.

Symptoms. The clinical picture of papillitis is characterized by severe inflammation. The gingival papilla acquires a bright red color, sometimes with a cyanotic tint, bleeds easily when eating, brushing teeth, etc. The disease is different chronic course, sometimes aggravated and proceeds in an acute or subacute form.

At histological examination a pattern characteristic of hypertrophic gingivitis is found. Sometimes the gingival papilla is covered with a narrow strip of keratinized epithelium. The epithelium is damaged in places, the connections between individual cells are broken. Proliferation of the basal layer of the epithelium, growth of fibrous connective tissue penetrating and epithelial layers, expansion of blood vessels, formation of new vessels, cell infiltration of the mucous membrane itself are noted.

X-ray picture indicates the presence of osteoporosis of the interdental septa. With a long course of papillitis, the phenomena of resorption of the apex of the septum, partial destruction of the compact plate at the apex,

Diagnosis of papillitis is not difficult. It is necessary to distinguish single developed papillitis (gingival polyp) from epulid, as well as from the pulp polyp, if the hypertrophied pulp has grown into the interdental space.

Forecast at proper treatment, especially in cases of development of papillitis from local reasons favorable in most cases.

Treatment of papillitis, as well as chronic hypertrophic gingivitis, consists primarily in the elimination of all local irritants, in the use of local medications and surgical means and funds overall impact on the body

Inflammation of the gingival papillae is accompanied by many unpleasant symptoms and talks about the development of serious diseases of the oral cavity.

The patient needs immediate treatment, as the pathological process can cause destruction and loss of teeth.

General view

Gingival papillae in dentists are called areas of soft tissue that fill the gaps between the teeth. They perform the function of protecting the periodontium.

The inflammatory process that develops on the soft tissues of the gums leads to difficulty in chewing food, retention of food debris in the interdental space and other problems.

The gingival papillae are one of the most sensitive areas of the soft tissues of the oral cavity. They are easily damaged by mechanical action.

Causes

The pathological process can develop as a result of non-compliance with the rules of hygiene. The condition of the teeth also depends on the health of the papillae.

That is why when unpleasant symptoms appear in the form of redness and swelling, you should contact a specialist for examination and treatment.

There can be several reasons for the occurrence of the pathological process. They are divided into local and general. The first group includes the following factors:

1. Smoking.
2. An insufficient amount minerals in organism.
3. Diabetes.
4. Violation of the hormonal background.
5. Infection.
6. Diseases of the gastrointestinal tract.
7. Pathologies of the cardiovascular system.
8. Reduced immunity.
9. Long-term use of certain groups of drugs.

Experts identify and local factors, which can increase the risk of developing an inflammatory process on the soft tissues of the oral cavity:

1. teething period.
2. Thermal, chemical burns.
3. mechanical effect on tissues.
4. Tooth stone.
5. Lack of oral hygiene, as a result of which pathogenic microorganisms begin to accumulate in periodontal pockets.
6. Poor quality prosthetics.

The reason for the spread of the pathological process may be the presence of a sharp edge of the crown or filling. In this case, inflammation is localized only at the site of damage to the gums.

Symptoms

The first signs of pathology are redness and swelling of soft tissues. In the absence of therapy, the pathological process captures large areas of tissue and causes bleeding, itching and discomfort. The gum hides the tooth for a third of its length.

If the patient does not turn to a specialist, there is a change in the shape of the gingival papilla. In severe cases, soft tissues cover the tooth for more than half of its height. This leads to pain, bleeding after eating, difficulty chewing.

In addition, inflammation is accompanied by the following symptoms:

1. Formation of pus in the interdental space.
2. Bad breath.
3. Growth of peridental soft tissues.
4. Change in the color of the mucous membrane affected by the pathological process.
5. Increased tooth sensitivity.
6. Change in tissue structure.

Lack of therapy leads to the development of many diseases of the oral cavity. The result is the destruction of soft and hard tissues.

Gingivitis and periodontitis

Pathology leads to the development of such unpleasant diseases as gingivitis and periodontitis. In this case, the inflammatory process affects significant areas of the oral mucosa.

Catarrhal gingivitis

Catarrhal gingivitis is the most frequent form inflammation of the soft tissues of the oral cavity. The first symptoms of the disease are:

1. Bleeding gums.
2. Puffiness.
3. Redness of the mucosa.
4. Unpleasant smell and taste.
5. Painful sensations when eating.
6. Changing the shape and relief of the gums.
7. General malaise.

Depending on the area of ​​​​damage to the mucosa and the intensity of symptoms, a mild, moderate and severe stage of development is distinguished.

Ulcerative gingivitis

The pathological process is a provocateur of necrosis of the gum tissue and inflammation of the lymph nodes. main reason disease becomes hypothermia. Certain types of bacteria can also cause ulcerative gingivitis.

Pathology manifests itself in the form of plaque on the periodontal tissues, which has a dirty gray color. Also, the symptoms of the disease are:

• Bleeding.
• Temperature increase.
• Paleness of the skin.
• Decrease or loss of appetite.

Ulcerative gingivitis should be treated with initial stage its development, since during the transition to a severe form it develops purulent inflammation, which leads to serious consequences.

The disease is characterized by the rapid growth of basal cells and connective tissue. The cause of the pathological process is hormonal changes and metabolic disorders.

Among the main symptoms are:

1. Soft tissue thickening. If left untreated, they begin to keratinize.
2. A noticeable increase in the size of the affected gum.
3. Mucosal discoloration.
4. Tissue sealing.

When eating and palpation occur pain varying intensity.

The video tells in more detail about the mechanism of development of gingivitis and its treatment.

Periodontitis

The disease manifests itself in the form of cyst formation on the upper part of the affected tooth. The formation cavity is filled with purulent masses, which causes swelling and soreness of the soft tissues.

A feature of periodontitis is that the cyst is temporary. It disappears under the influence of certain reasons and reappears.

The cause of the occurrence is pulpitis, improper installation of seals.

Inflammation during pregnancy

During pregnancy female body most susceptible to development various diseases oral cavity. This happens as a result of hormonal changes. Most often, diseases are diagnosed in the second and third trimesters of pregnancy.

In the absence of therapy, the pathological process spreads quite quickly, and general state getting worse. Inadequate treatment can cause premature birth or having an underweight baby.

Influence of orthopedic constructions

Poor-quality installation of prostheses or crowns that have hanging edges can also provoke the development of pathology. They injure the mucous membrane and soft tissues. As a result, an inflammatory process develops.

A complication in the absence of therapy is the formation in the interdental space big size periodontal pocket. Bacteria accumulate in it, which significantly aggravates the course of the disease.

Teething

One of the common causes of inflammation of the gingival papillae is the eruption of eights. Under normal conditions, there may be slight swelling.

You can cope with discomfort with the help of painkillers, but experts recommend contacting a dentist, as a purulent process may develop.

In this case, the doctor will perform antiseptic treatment or remove the wisdom tooth.

Specialist consultation

To assess the condition of the soft tissues and the oral cavity as a whole, the doctor will first of all conduct a visual examination.

Depending on the degree of the inflammatory process, sanitation and removal of dental plaque using ultrasound is carried out. Measures will help reduce the rate of reproduction of microorganisms.

The doctor also polishes the teeth to give them a smooth surface. As a result, it will not collect plaque, consisting of food debris and pathogenic microorganisms.

Methods and tactics of treatment

Treatment of pathological changes is carried out depending on the disease, the degree of its development and the characteristics of the course. The course of therapy is determined by the attending physician.

Anti-inflammatory therapy

Used to relieve inflammation antiseptic preparations and applications. When establishing gingivitis, Cholisal-gel or Chlorhexidine is prescribed for rinsing.

In the case when periodontitis has become the cause of the spread of inflammation, complex therapy is carried out with antibiotics or surgical intervention is prescribed.

Treatment of women during pregnancy is carried out in the same way as other patients. At the same time, the doctor selects those drugs that are allowed for pregnant women and are completely safe for the baby.

Antibiotics

Antibacterial agents are indicated for acute gingivitis and diseases caused by bacteria.

Drugs such as Augmentin, Lincomycin, Ofloxacin or Clindamycin are prescribed.

The choice of drug, dosage and duration of administration are determined by the attending physician. To exclude the development of dysbacteriosis, prebiotics and vitamin complexes are indicated.

Surgical intervention

Surgical intervention is carried out by coagulation of overgrown tissues. The method has been widely used. For the procedure, a special apparatus with an electrode is used, which is heated by means of an electric current.

The procedure allows you to quickly stop the development of the pathological process and avoid bleeding. As a result, the mucous membrane acquires a healthy color, pain disappears.

Treatment for injury

In cases where the inflammatory process was provoked by injury to the hanging edge of the gum, first of all, the specialist cuts off the interfering edge. A filling or denture may also need to be replaced.

Patients are also given drug therapy depending on the severity of the inflammation. The drugs are selected by the attending physician.

The video presents the tactics of treating inflammation of the gingival papillae.

Rules for choosing care products

This inflammation requires integrated approach to therapy. Along with taking medications, experts recommend observing the rules of hygiene.

To do this, you need to know how to choose the right toothpaste and brush:

1. When buying a dentifrice, you should pay attention to the composition. It should consist of natural ingredients such as chamomile, sage, cloves or St. John's wort.
2. Also, the composition should contain substances with antibacterial effect such as trilosan.
3. For permanent use, you can use pastes that have not only medicinal, but also preventive effect. They contain tea tree oil.
4. Do not use a brush with hard bristles, as it injures the mucous and soft tissues.

Preventive measures

To keep your teeth and gums healthy, you must follow the following preventive measures:

1. Introduce seafood into your diet.
2. Lead a healthy lifestyle.
3. Eat properly.
4. To refuse from bad habits.
5. Follow the rules of oral hygiene.

It is also important to treat any diseases in a timely manner when they are on initial stage development.