The gingival papilla is inflamed and painful. Papillitis: treatment, symptoms

The inflammatory process affecting the gingival papillae and gum margin, alternating with exacerbations/remissions, is called chronic gingivitis. The disease is manifested by congestive swelling of the gum surface, increased bleeding and deformation of the gums. The pathology is also characterized by an unpleasant odor of breath.

Diagnosis is made based on visual examination and records medical card. Treatment of a chronic form of inflammation consists of professional teeth cleaning, sanitation of the oral cavity with antiseptic solutions, etc.

Causes of the disease

Gingivitis, which has become chronic, is usually the result of poorly performed or incomplete treatment of the acute form of the pathology. That is why chronic gingivitis develops for the same reasons as its acute form.

These include:

Classification of the disease

Depending on the causes of the disease, there are the following types chronic gingivitis:

infectious;
thermal;
chemical;
traumatic;
caused by hormonal imbalances;
allergic.

Depending on the location of the inflammation, gingivitis can be:

Localized. If inflammation of the interdental papillae is diagnosed, then we're talking about about papillitis. With inflammation affecting the gum margin, we can talk about marginal chronic gingivitis.
Generalized form. Here the inflammation spreads to the entire surface of the gum.

There is also a gradation depending on the severity of the disease:

mild form (only the gingival papillae become inflamed);
moderate severity (inflammation also affects the marginal part of the gum);
severe form (the entire alveolar gum is involved in inflammation).

Symptoms of chronic inflammation

Gingivitis in chronic form Just like acute gingivitis, it has characteristic symptoms:

Types of chronic gingivitis

Depending on the nature of the inflammation, the following subtypes of chronic gingivitis are distinguished:

catarrhal;
hypertrophic;
atrophic.

Chronic catarrhal gingivitis

The disease in this case is a reaction to negative impact microorganisms present in bacterial plaque on the surface of teeth. Catarrhal form Chronic gingivitis develops as a result of poor oral hygiene. In the absence of adequate treatment, the pathology can transform into generalized periodontal disease.

Symptoms

The pathology clinic is quite typical:

bleeding;
itching in the gums that occurs as a result of mechanical stimulation of the gum surface.

Characteristic symptoms appear only during periods of exacerbation. But most often the disease is practically asymptomatic, developing rather slowly.

Advice! Chronic catarrhal gingivitis is diagnosed mainly in childhood and in young people 25-30 years old. At the same time general health the person remains without any changes.

Diagnosis of pathology

Diagnosis is made based on visual examination. The doctor notes the presence of tartar and signs of chronic inflammation of the gums - hyperemia and swelling. The formation of periodontal pockets is not typical for the disease. And the teeth remain on former places without moving.

Treatment of the disease

Treatment of chronic pathology involves the following steps:

Advice! The basis of treatment for chronic catarrhal gingivitis is high-quality oral hygiene.

At severe course disease, antibiotics are prescribed.
Excellent results are obtained using physiotherapeutic procedures.

Chronic hypertrophic gingivitis

This form of pathology is characterized by long-term inflammation, accompanied by overgrowth of gum tissue. No resolution of the periodontal junction is observed.

Main symptoms of the disease

The key sign of pathology is an increase in gum volume. But besides this, there are other striking symptoms:

strong painful sensations, accompanying touching the inflamed surface;
bleeding that accompanies even light touches of the damaged gum;
pain when eating (this especially applies to hot, spicy and salty foods);
An increase in the volume of gum tissue causes difficulty in eating food, interfering with its quality chewing.

Depending on the clinic of the pathology, two subtypes are distinguished hypertrophic form:

granulating gingivitis;
fibrous pathology format.

For granulating hypertrophic gingivitis The following manifestations are typical:

increase in gum size;
intense dark red color;
significant swelling;
pain on palpation;
presence of proliferates;
bleeding that occurs with any touch;
formation of periodontal pockets.

Advice! Granular gingivitis most often affects large areas of the gum.

With the fibrotic course of hypertrophic gingivitis, the following conditions are observed:

increased gum density;
no pain, the surface often retains its usual color;
no bleeding;
the gum volume increases slightly;
deformation is observed only in places where the pathological process is occurring.

Gum overgrowth is determined by three degrees:

In the first degree, the edge of the gum becomes slightly thicker.
For the second degree, enlargement of the papillae is typical.
In the third degree, significant growth of the gum margin and gingival papillae is diagnosed. Visually, the gums take on the appearance of a dense cushion almost completely covering the teeth.

Treatment of hypertrophic gingivitis

Before choosing a treatment regimen, it is necessary to remove tartar and polish the surface of the teeth. The procedures are performed in the dentist's office. And only after this can treatment be selected based on the type of hypertrophic gingivitis:

At severe swelling Applications to the affected surface are prescribed. Potassium iodide, maraslavin, 3% copper sulfate can be used here. In severe cases, injections of hydrogen peroxide or glucose are prescribed, which are injected into the apex of the gingival papillae.
In the case of the fibrous form, lidase, previously dissolved in novocaine, is administered into the interdental papillae. In severe cases, surgical treatment is prescribed (excision of the hypertrophied gingival area), after which the use of heparin or hydrocortisone ointment is prescribed.
If gingivitis is caused by an allergic reaction, then treatment is carried out with ointments containing glucocorticoids.

Additionally, physiotherapy is prescribed (at the discretion of the attending physician):

electrophoresis (with heparin);
diathermocoagulation;
laser therapy;
performing a massage.

This form of pathology, in addition to its chronic course, is characterized by a decrease in the volume of the gums. The reason for this is the drying out of the gingival papillae and gum margins. It differs in the localization of inflammation and can be:

in the form of a limited area of gum atrophy (diagnosed more often);
diffuse form (spread over the entire surface).

Chronic atrophic gingivitis – a clear sign beginning periodontal disease. Periodontal inflammation is quite difficult to treat and has a recurrent course.

Treatment of the disease

Treatment of pathology is carried out exclusively under the supervision of a doctor. Self-medication can lead to serious complications. Treatment involves an integrated approach, since it is necessary to eliminate not only the symptoms, but also the root cause of the pathology.

Therapy for atrophic gingivitis can be performed in two ways:

conservative treatment;
surgical intervention.

Conservative treatment involves the following scheme:

it is necessary to carry out high-quality dental sanitation of the oral cavity (heal carious teeth, remove tartar and microbial plaque);
all sharp edges of the teeth should be polished (this will reduce the risk of injury to the inflamed gum);
after completion of dental procedures, gum treatment with hydrogen peroxide is prescribed (up to two times a day);
the use of applications with healing preparations (sea buckthorn or rosehip oil);
taking vitamin complexes;
mouth sanitation (rinsing) herbal decoctions with good tanning properties - oak bark or calamus;
Physiotherapy may also be prescribed.

Advice! Treatment of atrophic gingivitis with antibiotics is possible only as prescribed by a doctor.

If improvement cannot be achieved, it is recommended to carry out surgical intervention. Treatment consists of ginginoplasty, which involves replacing missing areas of gum with healthy tissue taken from adjacent areas.

Diagnosis of chronic gingivitis

The diagnosis is made based on a visual examination:

General treatment of chronic gingivitis

In general, treatment of pathology looks like as follows:

carrying out sanitation of the oral cavity with antiseptic solutions (applications are also carried out);
mandatory removal of tartar, after which antiseptic treatment must be carried out;
careful hygiene oral cavity;
in severe cases of the disease, anti-inflammatory and antimicrobial agents may be prescribed.

Physiotherapy provides excellent results in the treatment of chronic gingivitis. An excellent prevention of the disease is regular visits to the dentist's office.

Papillitis is an inflammation of the gingival interdental papilla, related to superficial inflammatory periodontal diseases; in a number of literary sources, papillitis is considered as a localized type of gingivitis.

1. Causes of papillitis

The causes of papillitis can be traumatic, infectious or allergic factors. Less commonly, papillitis is a manifestation of endogenous pathology - in diseases of the metabolic system, endocrine pathology, cardiovascular diseases. Definition immediate cause, which led to the development of the disease, is necessary to prescribe adequate therapy for the pathology.

2. Classification of papillitis

The basics of the classification of papillitis make it possible to determine the form and nature of the course of the disease, help clarify the diagnosis and adjust the treatment plan for the disease.

According to the variants of the course, acute papillitis and chronic papillitis are distinguished.

According to the form of the disease, acute papillitis can be catarrhal or ulcerative. The forms of chronic papillitis are catarrhal, ulcerative and hypertrophic forms.

With papillitis, the inflammatory process usually involves one or two gingival interdental papillae.

3. Symptoms of papillitis

The symptoms of papillitis depend on the nature of the disease and clinical form pathology. Thus, acute papillitis is characterized by the greatest severity of local inflammatory phenomena - redness, swelling, pain and bleeding of the affected gingival interdental papilla. However, in the chronic course of the disease, all symptoms can be smoothed out, the color of the gums changes to dark red or cyanotic, which reflects the progression of arterial and venous circulation, and pain can only appear during the period of exacerbation of the disease. In addition, the form of papillitis leaves a visible imprint on the clinical picture of the disease.

In the ulcerative form of papillitis, an area of ulceration is observed in the area of the gingival interdental papilla against the background of the above-described local signs of inflammation; in the hypertrophic form, along with the picture of inflammation, there is a “proliferation” of tissue in the form of granulomas or fibromas, which requires differential diagnosis with other diseases. In some cases, to clarify the diagnosis, it is necessary histological examination. At histological analysis describes the appearance characteristic of the hypertrophic form of papillitis - gum mucosa with proliferation of cells of the basal layer, against the background of proliferation of the fibrous connective base and blood filling of the capillaries, sometimes individual cells with elements of parakeratosis are detected. As a rule, the diagnostic algorithm also uses x-ray examination, which often reveals osteoporosis of the interdental septa. In the chronic course of the disease, resorption of the apex of the septum and partial destruction of the compact lamina at the apex are often detected. During probing with instruments, no abnormal pathological pockets in the gums are detected.

4. Treatment of papillitis

Before prescribing therapy for papillitis, determine in each individual case causal factors its occurrence. Due to the variety of etiological factors of papillitis, tactics dental care requires strict individualization.

Treatment of papillitis of traumatic etiology is carried out comprehensively. After carrying out antibacterial, anti-inflammatory therapy and relieving the severity of the inflammatory process, methods aimed at eliminating the traumatic factor can be used in the treatment of papillitis. Thus, in case of pathological position of the tooth, the presence of its crowding, various orthopedic methods of influence are used, including when at a young age patients (up to 30 years old) and the insignificance of the required restructuring - orthodontic treatment. For papillitis resulting from acute injury to the gingival papilla, after the severity of the inflammatory phenomena has been relieved, it is recommended to use indirect methods restorations - cast inlays or crowns for more precise restoration of contacts between teeth.

Treatment of papillitis, which forms as a result of the traumatic impact of a defective crown, begins with the removal of this crown and the (later) administration of drug therapy aimed at relieving inflammatory phenomena. In such cases, during repeated prosthetics, the quality of tooth processing is assessed and defects in tooth preparation for a crown are corrected.

In case of the infectious nature of the disease, which develops as a complication of the cervical caries process, treatment is carried out from the standpoint of the treatment of dental caries, with the parallel use of anti-inflammatory therapy.

Treatment of papillitis of allergic etiology inherently includes the administration of antiallergic drugs. - you can find out here.

IN in rare cases, with pronounced chronic hypertrophic papillitis in the “cold period”, local surgical options are possible, aimed at removing excess tissue growth.

DISEASES OF THE ORAL MUCOSA

According to their manifestations, diseases of the mucous membranes of the oral cavity can mainly 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. Recognizing all these diseases requires first of all knowledge normal anatomy and physiology of the oral mucosa, the ability to examine 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 oral mucosa consists of three layers: 1) epithelium (epithelium); 2) the mucous membrane itself (mucosa propria); 3) submucosa (submucosa).

Epithelial layer formed by stratified squamous epithelium. The epithelial layer contains cells various shapes- from cylindrical, cubic layer to completely squamous epithelium surfaces. As in the skin, the epithelial cover can be divided 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 epithelium of the mucous membrane. Its lower row consists of cylindrical, densely colored cells, with their narrow side facing their own membrane. These cells are considered to be the germinal layer of the germinal layer. It is followed by several rows of flatter cells, which are also well painted and connected to each other by jumpers. Then there are layers of cells that are in various stages of keratinization: 1) granular layer - the initial degree of keratinization, 2) transparent layer - a more pronounced degree of keratinization, which is the transition to the last, clearly defined stratum corneum. The transparent layer of epithelium on the oral mucosa is mainly observed in those places where keratinization manifests itself with greater intensity.

Actually mucous membrane formed by dense connective tissue with a fibrillar structure. The connective tissue of the membrane itself contains small blood vessels such as capillaries and nerves. The membrane at the border with the epithelium forms papillary outgrowths. These papillae come in different 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 equipped nerve fibers- sensitive and motor. The innervation of the mouth involves the cranial and spinal nerves, as well as cervical region sympathetic nerve. The following cranial nerves approach the walls of the oral cavity: trigeminal, facial, glossopharyngeal, sublingual, and partly vagus.

To study the oral mucosa, we use a number of techniques, which, depending on the characteristics of the case, are used in varying numbers and combinations. The main examination of the oral cavity consists of the following points: 1) survey, 2) examination, 3) palpation, 4) microscopic examination. In addition, research is being conducted general condition the body and individual systems and organs, and often additional serological, hematological and other laboratory tests.

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

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

Inflammatory processes in the tongue, especially ulcerative or other diseases leading to limited mobility of this organ, make it difficult to pronounce almost all consonant sounds, which leads to a lisp (dyslalia labialis). In case of defeat posterior section The pronunciation of the sounds “g” and “k” especially suffers.

In case of integrity violations hard palate(syphilis, congenital cleft defects, injuries) and when the soft palate is damaged, even slightly, speech takes on a nasal tone: all consonants are pronounced nasally. The pronunciation of the so-called closed consonants is especially impaired: “p”, “b”, “t”, “d”, “s”. This speech disorder is called rhinolalia aperta in contrast to rhinolalia clausa (dull sound). The latter disorder is observed during infiltrating processes of the palatine velum.

The doctor pays attention to all these disorders at the beginning of the conversation with the patient, thus introducing elements of a functional study of the mouth into the survey.

Particular attention should be paid to complaints of difficulty and pain during eating, mainly when the soft palate is affected. Swelling of the palate and pain interfere with the normal act of active swallowing. If the integrity of the palatine vault is damaged, liquid food flows into the nose. Small abrasions on the hard palate often cause severe pain when eating solid food. Painful lesions of the tongue also cause difficulty in eating solid food; liquid food passes more easily. Complaints of painful eating may also occur if the vestibule of the oral cavity is affected. With stomatitis and ulcerative processes in the mouth, patients complain of bad breath (foetor ex ore).

It is important to establish a connection between mucosal lesions and some other diseases. In the presence of stomatitis and stomatosis, it is necessary to pay special attention for general infectious diseases, diseases of the digestive system, metabolism.

In acute cases, it is important to determine the presence of any acute general infection, for example, influenza. Often, influenza infection can precede stomatitis. For some acute diseases damage to the mucous membrane provides very valuable diagnostic signs, for example, Filatov’s spots in measles. Often stomatitis complicates some general debilitating disease or follows a disease, especially often after the flu. Acute as well as chronic lesions of the mucous membrane can be associated with skin diseases, general poisoning (drug, occupational, etc.), diseases gastrointestinal tract(anid and anacid gastritis, membranous colitis, etc.), helminthic infestation, nutritional disorders (vitaminosis - scurvy, pellagra, etc.), blood diseases (anemia, leukemia, etc.). Specific infections - tuberculosis and syphilis - should be highlighted. Diseases of the endocrine glands, 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. Regardless of the intended diagnosis, all parts of the mouth should be examined. It is necessary to examine the mouth at very good lighting, preferably during the day. Not only the affected area is subject to examination, but the entire mucous membrane of the oral cavity and the affected areas of the mucous membrane of the pharynx, skin, perioral area and face.

Lips and cheeks. The oral mucosa mainly differs from the skin in the presence of a thin epithelial layer and very slight keratinization surface layers, abundant blood supply due to the presence of a dense vascular network, lack hair follicles and sweat glands, a small amount sebaceous glands, which are predominantly located in the area of the mucous membrane of the lips from the corners of the mouth to the free edge of the teeth. The skin located at the junction with the mucous membrane in the area of the red border of the lips is also close in structure to the mucous membrane. These features of the latter, as well as the presence of bacteria and a moist, warm environment in the form of oral fluid, cause different manifestations of the same origin of lesions on the mucous membrane and skin.

The examination begins from the vestibule of the mouth. Using a mirror, spatula or hook, first pull back the lip, then the cheek. On the inner surface of the lip, thin superficial veins are visible from under the mucous membrane and intertwined strands of loose connective tissue and the orbicularis oris muscle protrude. Upon closer examination, sparsely scattered small yellowish-white nodules can be seen. This sebaceous glands. In people suffering from seborrhea, 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 cheek, 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 area of molars and premolars. Acinous glands are also found on the mucous membrane of the cheeks. There are fewer of them here than on the lip, but they are larger in size. A particularly large gland is located opposite the third upper molar (gianduia molaris). It should not be confused with a pathological formation. During 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 you pull back the cheek, you can see a small protrusion like a papilla, at the top of which the stenon duct opens - the excretory duct of the parotid gland. To determine the patency of the Stenon's duct, the examination can be supplemented with probing. The direction of the Stenon's duct in the thickness of the cheek is determined by a line drawn from the earlobe to the red border of the upper lip. Probing is done using a thin, blunt probe; 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 stenope duct passes through m. buccinator. Unless absolutely necessary, probing is not recommended to avoid infection and injury. Is it easier and safer to examine gland function through massage? massage the area of the parotid gland from the outside; the doctor observes the opening of the duct; saliva flows normally. When the gland becomes inflamed or the duct is blocked, saliva is not released, but pus appears.

In the transitional fold, mainly at the point of transition of the mucous membrane of the cheek to the gum, in the area of the upper molars, blood vessels, especially veins, are sometimes clearly visible. 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 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, sometimes tooth marks are visible on it, and its mobility is sharply limited.

In addition to inflammatory processes, swelling of the mucous membrane is observed in heart and kidney suffering, in 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).

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 there are symmetrical, transverse elevations of the mucous membrane (plicae palatinae transversae), which smooth out with age. The relief of the mucous membrane of the palate is significantly distorted under the influence of wearing plastic prostheses. In the midline of the central incisors there is a pear-shaped prominence called the palatine papilla (papilla palatina). In some subjects it may be pronounced, but it should not be mistaken for a pathological formation. The area of the palatine papilla corresponds to the location of the incisive canal upper jaw(sapalis incivus). Sometimes in the middle of the hard palate there is a rather sharply protruding longitudinally located elevation (torus palatinus). This formation represents a thickening of the palatine suture (raphe palatini), and it also cannot be considered pathological. Numerous glands are embedded in the thickness of the mucous membrane covering the palate. They are located mainly in the mucous membrane 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 extend to the soft palate. The mucous membrane of the palate rarely looks like a uniformly colored cover. In smokers, it is almost always inflamed and colored deep red. For liver damage and biliary tract The color of the soft palate sometimes takes on a yellowish tint; in case of heart defects, it becomes bluish.

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 pink with a matte tint. However, the tongue is often coated or coated, most often gray-brown in color. Any raid must be regarded as pathological phenomenon. Sometimes the tongue, even in its normal state, may appear covered with a white coating, which depends on the length of the filiform papillae (papillae filiformes) scattered along its upper surface - the back and root. This plaque may disappear with age, and sometimes change during the day (more pronounced in the morning, less pronounced by the middle of the day, after meals).

The tongue, as a rule, becomes coated in cases where, due to inflammatory processes and pain in the oral cavity or other reasons, its normal mobility is disrupted or speech, chewing, swallowing is difficult, or there is a disease of the stomach or intestines. In such cases, plaque appears not only on the back and root of the tongue, but also on the tip and 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. I.P. Pavlov believes that the basis for the occurrence of plaque is the neuroreflex mechanism.

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

When examining the lateral surface of the tongue at the root, rather thick venous plexuses are visible, which can sometimes mistakenly appear 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 covering of the floor of the oral cavity on the sides. Two sublingual folds (plicae sublinguales) extend from the frenulum on both sides, under which the sublingual glands are located. Closer to the middle, lateral from the intersection of the hyoid fold and the frenulum of the tongue, there is the so-called sublingual caruncle (caruncula sublingualis), in which there are the outlet openings of the sublingual and submandibular salivary glands. Inward 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 located at the tip of the tongue or at the place where the mucous membrane transitions from the bottom to the bottom surface language. During inflammatory processes that spread to the floor of the mouth, the caruncle swells, rises, the mobility of the tongue is limited, and the tongue itself moves upward.

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

Firstly, type of mucous membrane: a) color, b) shine, c) surface character.

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

Changes in the normal luster of the mucous membrane depend on damage to the epithelial cover: keratinization or disruption of integrity (inflammatory and blastomatous processes), or the appearance of fibrinous or other layers (aphtha).

Surface character may vary depending on changes in the level of the mucous membrane. Based on the depth of destruction of the latter, one should distinguish: 1) abrasions (erosions) - 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 (deep scars form during healing). Violation of the integrity of the mucous membrane during abrasions and ulcers causes changes in the level of the mucous membrane - a decrease in it. Scars, on the contrary, for the most part produce a limited increase in levels on the mucosal surface. However, atrophic scars are known (with lupus), causing a decrease in the level of the mucous membrane. A decrease is also observed in retracted scars after deep destruction of the mucous membrane.

Hypertrophic productive forms of inflammation of the mucous membrane also noticeably change its appearance.

Changes the surface relief of the mucous membranes and the presence of nodular and tuberculate 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 papule is based on proliferation cellular elements in the papillary and subpapillary layers, accompanied by dilation of the superficial vessels. Papular rashes on the mucous membrane are observed mainly during inflammatory processes [syphilis, red lichen planus(lichen ruber planus)]. Large papules (plaques) are observed with aphthous stomatitis, sometimes with syphilis.

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

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

Thus, studying the appearance of the mucosa can be valuable for diagnosis. Determination of color, gloss, and level must also be supplemented with 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 mostly limited and strictly localized in the area of the upper front teeth. Lupus erythematodes has a favorite localization on the oral mucosa - mainly the red border of the lips and the inner surface of the cheek in the area of the molars. Lichen planus is located mainly on the mucous membrane of the cheek according to the bite line.

Next, one should distinguish a confluent lesion from a focal one, when the elements are located separately. In the oral cavity, the focal arrangement of elements produces predominantly syphilis. In tuberculous and common inflammatory processes, a confluent arrangement of elements is observed. Almost always, when examining the oral cavity, the outer coverings should also be examined.

Below is an inspection diagram.

Inspection scheme

1. Statement of damage to the mucous membrane.

2. Nature of appearance and course.

3. The main elements of the lesion.

4. Grouping elements

5. Growth of elements.

6. Stages of development of elements.

For a spot

1. Size.

3. Coloring.

4. Durability.

5. Topography.

6. Current.

7. Availability of other elements.

For papule and tubercle

1. Size.

3. Coloring.

4 Stages of development.

5. Topography.

For ulcers

1. Size.

5. Depth.

6. Secret.

7. Density.

8. Soreness.

9. Surrounding tissue

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 palpation examination and palpation. This cannot be neglected.

Examination of the outer integument is aimed mainly at establishing changes in the color and appearance of the skin, and the presence of swelling. Such an examination usually does not provide solid indicative signs, since the appearance of the swelling often says little about its nature and origin. Swelling of the cheek 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 a tumor process. To establish the nature of the swelling, it is necessary to perform a palpation examination.

TO palpation examination mouth lesions have to be resorted to quite often. Palpation must be performed when examining oral tumors, some ulcers, and in all cases of lesions of an unknown nature.

When palpating a tumor, in addition to its consistency, one should determine the depth of its location, the mobility of the tumor itself and the mucous membrane above it, and its connection with surrounding tissues and organs. When palpating an ulcer, the doctor should be interested in its density, edges and the nature of 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 rim around the ulceration. Feeling a cancerous ulcer is painless. On the contrary, palpation of a tuberculosis ulcer often causes pain. The edges of a tuberculous ulcer are slightly compacted and do not give the feeling of a cartilaginous ring when palpated, which is so characteristic of cancer. Sometimes a hard chancre or syphilitic ulcer on the lip or tongue, cheek, due to the presence of a dense painless infiltrate, can be difficult to distinguish by touch from a cancerous ulcer.

Nonspecific ulcers of the oral mucosa, when palpated, for the most part differ significantly from those described above due to their superficial location. However, it should be kept in mind here chronic ulcers of traumatic origin, especially located on the lateral surface of the tongue, at its root. These ulcers, due to trauma constantly caused by a carious tooth or poorly fitted prosthesis, are surrounded by a fairly dense infiltrate. And yet they remain more superficial and less dense than with 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 carried out in search of inflammatory infiltrates, neoplasms, and when examining the lymphatic system. It is recommended to feel the soft tissues of the face with the head well fixed.

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

Lymph nodes. Especially often it is necessary to examine the lymph nodes. As is known, the study of nodes is of great importance for the clinical assessment of inflammatory and blastomatous processes. Lymph from the soft and hard tissues of the mouth is drained through the following system nodes The first stage - submandibular, chin, lingual and facial lymph nodes; second - superficial and upper deep cervical nodes; third - lower deep cervical nodes. From the lower deep cervical nodes, lymph enters the truncus lymphaticus jugularis.

Individual areas of the mouth and dental system are connected to the first stage lymph nodes 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 chin 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 to the submandibular lymph nodes, with the exception of the middle part lower lip, giving lymph first to the mental nodes. The back part of the gums of the lower jaw gives lymph to the submandibular nodes and deep cervical nodes, and the front part - to the mental nodes; the gums of the upper jaw - only in the deep buccal, the tongue - in the lingual and directly in the upper deep cervical. The palate is connected directly to the deep facial lymph nodes (Fig. 177, 178).

Palpation of the chin and submandibular lymph nodes is carried out as follows. The doctor stands to the side and slightly behind the patient. The patient relaxes the neck muscles by slightly tilting his head forward. Using the tips of the three-middle fingers of both hands, the doctor penetrates from the right and left into the submandibular region, pressing the soft tissues. The thumbs rest on the lower jaw, fixing the head. The submandibular nodes are located inward from the edge of the lower jaw in the following order. In front of the submandibular salivary gland there are 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 mental nodes are located along the midline of the chin between the geniohyoid muscles (Fig. 177).

To palpate the facial lymph nodes, it is more convenient to use a two-handed examination: one hand fixes and lifts the cheek from the inside, the other palpates the glands from the outside. Sometimes it is useful to use a two-handed examination when palpating the submandibular and mental lymph nodes, for example, in very obese subjects with inflammatory infiltration of soft tissues, etc. The facial lymph nodes are located mainly on the buccal muscle in the space between the masseter and orbicularis oris muscles. The cervical nodes run along the internal jugular vein.

When palpating the lymph nodes, it is important to determine their size, consistency, mobility and pain. Normally, the lymph nodes are not palpable at all or are vaguely palpable. Acute inflammatory processes in the mouth cause an increase in the corresponding nodes; the lymph nodes become painful when touched. In these cases, acute perilymphadenitis may also appear; the nodes are palpated in 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 packets. With cancer in further stages of its existence, limited mobility of nodes may be observed due to metastases. Chronic perilymphadenitis is considered characteristic of tuberculous lesions of the lymph nodes.

Gum inflammation is a fairly common disease that occurs in both adults and children. Today many people complain about increased sensitivity and bleeding gums. When your gums become inflamed and bleed, your mood plummets. And there is a reason. Not only does a smile with inflamed gums look, to put it mildly, unattractive. So, there are also painful sensations and bad breath. And toothache can happen. Why should there be a good mood here? And when you think that inflammation of the gums can lead to loss of teeth, the melancholy overwhelms you.

Gum inflammation

If you feel that there is swelling of the gums, pain, blood, painful sensations when eating hard, hot or cold food, and sometimes suppuration at the base of the teeth or their loosening - a sign of one of inflammatory diseases oral cavity.

Gingivitis - initial stage inflammation the surface of the mucous membrane of the gingival papillae between the teeth or the edge of the gums near the tooth. It manifests itself in the form of increased sensitivity, pain, redness, swelling and bleeding of the gums, sometimes the pain radiates to the temple or ear.

The cause may be damage to the mucous membrane when eating, brushing teeth, or traumatic installation of fillings, dentures, crowns or braces. May occur in those with malocclusion or short bridle lips.

Gingivitis is a fairly common disease, the treatment of which must be taken seriously. If left untreated, gingivitis can progress to the more serious disease periodontitis.

Gingivitis can occur as an accompaniment of the underlying disease, which should be treated first.

Also found gingivitis during pregnancy, which may be accompanied by swelling of the gums, bleeding, the appearance of pus and odor from the mouth. Painful sores may appear and the temperature may rise.

Gingivitis in children occurs if the rules of oral hygiene are not followed or the mucous membranes in the oral cavity are injured, as a result of which microbes enter it, causing inflammation. The reason may also be lack of vitamins and minerals in the body and during teething. Children's gingivitis is treated in the same way as in adults, but in more gentle ways.

Periodontitis

Periodontitis is usually considered advanced gingivitis. It is accompanied by tooth mobility, periodontal pockets appear with leaking pus, the bone around the teeth atrophies, periodontitis penetrates into the bone, and the roots are exposed. If timely treatment is not carried out, teeth will fall out over time.

With these diseases, gum inflammation occurs in the area of either single or all teeth.

Periodontal disease

Periodontal disease occurs as a result slight or uneven load on teeth. Accompanied slight bleeding, usually without pain, and with a small amount of tartar. It develops slowly, but if left untreated, leads to periodontitis. Most often found in older people.

Bleeding gums is not an independent disease. Most often observed when brushing teeth as one of the symptoms of gingivitis or periodontitis.

If the gums become swollen due to periodontitis, which is caused by an infection in the tooth canals, it is useless to treat gum inflammation. Necessary fill root canals.

If your gums are injured as a result of incorrect, traumatic installation of fillings, crowns, dentures or braces, you should first consult a dentist to eliminate the cause. Without this, gum treatment will not be effective.

Causes of gum inflammation

Usually distinguish internal and external reasons the occurrence of gum inflammation. TO external reasons as a result of exposure include:

poor oral hygiene or its complete absence or improper care;
presence of tartar;
improper installation of fillings, dental crowns, prosthetic braces;
malocclusion;
smoking.

Internal reasons are:

diseases of internal systems and organs (gastrointestinal tract, cardiac, hematological, diabetes mellitus etc.);
immunodeficiency;
lack of vitamins in the body;
medications taken;
genetic problems;
sometimes pregnancy.

That is, most often gum inflammation associated with dental infection or other pathology of the human body. It can lead to serious complications and disorders in the body.

Treatment options at home

Gum inflammation can be treated using different methods. In any case, in order not to harm your health and prevent the development of more serious diseases, before starting treatment, you must consult a dentist to determine the diagnosis.

In serious cases, the doctor will prescribe treatment, in combination with which additional home remedies will provide a good effect.

In simpler cases, it is enough to use at home products that provide anti-inflammatory, antiseptic, decongestant and analgesic effects.

When talking about ways to treat gums at home, there are: medicinal products pharmaceutical (medicinal) and folk.

Pharmacy products

Pharmaceutical products include rinses, sprays, applications, toothpastes and gels. All pharmaceutical drugs are supplied with instructions for use, which must be followed and followed in order to obtain the desired result.

Modern pharmacology has created on the basis of healing natural remedies And medicinal plants natural safe and effective drugs.

For bleeding and inflammation of the gums, various pharmaceutical products are used that relieve inflammation, relieve pain, eliminate bleeding, itching and burning, relieve swelling and disinfect the mucous membrane from microorganisms and bacteria.

Antiseptic rinses include:

Listerine (2 times a day for 30 seconds) is one of the most effective rinses.
Stomatophyte (3-4 times a day for 10-15 days).
Furacilin (2-3 times a day).
Chlorhexidine (spray 0.2% for periodontal disease and 0.05% for childhood gingivitis - after each meal until recovery).
Miramistin (3-4 times a day).
Chlorophyllipt (3 times a day with a diluted solution).
Rotokan (until inflammation is eliminated).
Hydrogen peroxide (solution 1 tbsp in 100 ml of water 2 times a day).
Malavit (10 drops/glass of water for rinsing 1 week daily).
“Forest balm” (after each meal until symptoms disappear).

The effect of treatment with rinses can be enhanced by simultaneously using compresses and applications with medicinal pastes, gels and ointments.

Therapeutic gels and ointments form a protective film on the mucous membrane. They are applied to the gums several times a day, after rinsing. The most effective means:

Special toothpastes have also proven effective in the treatment and prevention of bleeding and inflammation of the gums. They contain extracts of medicinal herbs and anti-inflammatory ingredients. For gum inflammation, it is recommended to use toothpastes:

Folk remedies for treatment

To get really positive healing effect and the disease has not progressed, before deciding how to treat gum inflammation at home, it is recommended to consult a specialist not only to establish a diagnosis, but also, if necessary, to do cleaning, remove tartar and get basic prescriptions.

As a rule, the use of folk remedies has centuries of experience. Medicinal plants as in pure form, and in combination with other plants, are increasingly used for the prevention and treatment of diseases of various etymologies. An important advantage of medicinal plants is their low toxicity and lack of side effects in most cases.

Typically you will need to prepare infusion, decoction or alcohol tincture based on medicinal plants for rinsing the mouth, preparing compresses or medicinal applications.

Medicinal herbs have antibacterial (calendula, chamomile), anti-inflammatory and analgesic (sage, yarrow), astringent and strengthening (oak bark, St. John's wort) properties.

For simple inflammation, rinsing with a decoction or infusion may be sufficient. But herbal infusions They do not last long, it is advisable to cook them daily. Most effective and safe sage, burnet, yarrow, chamomile, calamus, oak bark, sorrel, St. John's wort, linden blossom, calendula, eucalyptus and many others.

Below are some of the simplest recipes for treating gums with home remedies.

First aid for gum disease

In case severe pain To treat gums at home before visiting a doctor, it is recommended to rinse your mouth with the following solutions:

potassium permanganate;
baking soda;
chlorhexidine;
furatsilina.

Or use ointments that will reduce bleeding gums, have an antiseptic effect and reduce pain.

The main thing is to under no circumstances resort to radical methods of self-medication, as this can cause more serious consequences. In order to stop the spread of inflammation, it is best apply various infusions, having antimicrobial effect. The pharmacy sells such highly effective products as Stomatidine, Mevalex and Givalex without a prescription. They should be used according to the recommendations included in the package.

Gingivitis- inflammation of the gum mucosa. Like any inflammation, gingivitis can be considered as a protective-adaptive reaction of the entire organism to the action of a pathogenic stimulus, manifested at the site of tissue damage by changes in blood circulation, increased vascular permeability, edema, degeneration or proliferation of cells.

In accordance with the classification of periodontal diseases recommended by the XVI Plenum of the Board of the All-Union Scientific Society of Dentists, the group of gingivitis includes following forms diseases of marginal periodontium: serous (catarrhal), hypertrophic (proliferative), necrotic.

Of the listed forms, serous gingivitis is the most common. In the orthopedic dentistry clinic, a type of gingivitis is encountered - papillitis - inflammation of the gingival interdental papilla.

This section examines in detail serous (catarrhal) and hypertrophic gingivitis, one of the etiological aspects of which is anomalies in the development of the dental system, medical interventions, including post-orthopedic interventions.

Clinical picture

The disease is manifested by inflammation of the gingival margin, which can vary in degree and nature. The process is localized or generalized. In some cases, the disease begins acutely, with patients noticing itching in the gums, pain when eating, and bleeding gums, especially when brushing their teeth. Bleeding gums - characteristic symptom gingivitis.

In chronic gingivitis, which begins unnoticed by the patient, complaints are inconsistent and most often boil down to periodic or increasing bleeding of the gums and itching in the gums. Often the process is asymptomatic. These subjective sensations are also characteristic of hypertrophic gingivitis, which develops on the basis of serous inflammation. These symptoms are accompanied by complaints of a feeling of swelling, changes in the shape of the gums, and sometimes the appearance of spontaneous bleeding of the gums, even at night.

Acute papillitis is accompanied by sharp, sometimes paroxysmal pain, sometimes radiating to adjacent teeth. The pain is pulpitic in nature, but decreases with warm rinsing or disappears for no reason.

During an examination during an acute process, a sharp hyperemia of the gingival margin, including the gingival papilla, and swelling of these areas are determined. Due to inflammatory infiltration, the surface of the gums is smooth, stretched and becomes similar to an orange peel. Swelling of the marginal margin mimics the formation of a pathological pocket, especially in the area of the gingival papilla. Palpation and light touch with a probe cause bleeding.

The color of the inflamed area of the gum is bright red, with a clear boundary between the unaffected areas.

With chronic gingivitis, the phenomena of circulatory disorders and venous stagnation, which causes the affected area to appear dark red or bluish.

The presence of pathological pockets is not determined by probing.

If there are dentures in the oral cavity, the clinical picture retains the general symptoms, but has some specifics, which largely depend on the quality of the denture. When using fixed dentures, gingivitis in the area of the supporting teeth and the body of the prosthesis is more pronounced, especially if the dentures are made poorly. In these cases, gingivitis is localized, coinciding with the location of the prosthesis. Promotes the development of gingivitis after prosthetics and insufficient hygiene care for fixed dentures. If the patient uses removable dentures - clasp or plate, poor hygienic care for them can lead to the development of gingivitis and stomatitis (see differential diagnosis below). The phenomena of gingivitis in these cases are more severe in the areas of traumatic impact of the prosthesis.

On radiographs in acute gingivitis, the pattern of bone tissue is normal. At long term Chronic serous and hypertrophic gingivitis can establish resorption of the endplate of the interdental septa.

Lubricating the gums with Lugol's solution makes it possible to clarify the prevalence and partly the degree of the inflammatory process, since iodine preparations are well fixed by glycogen, the content of which in the gums increases as the inflammatory phenomena increase.

Depending on the location and inflammation in the gums, there are: 1) mild gingivitis - inflammation affects only part of the gingival papilla or the marginal edge; 2) moderate gingivitis - inflammation spreads to part of the alveolar gum; 3) severe gingivitis - the inflammatory process spreads to the entire alveolar gum.

According to prevalence, they are distinguished: 1) focal gingivitis - the gums of one or a group of teeth are affected; 2) diffuse - the gums of all teeth of one or both jaws are affected.

Etiology and pathogenesis

A large role in the occurrence of the disease belongs to the constant irritation of the gum mucosa by metabolic products (toxins) of the microbial plaque of soft dental plaque. Poor oral hygiene, especially in the presence of dentures, is considered one of the leading etiological factors.

Local causes include supragingival tartar, the edge of an artificial crown (wide or long), overhanging edges of fillings, inlays, lack of interdental contact points, malocclusion, tooth position, and abnormal tooth shape.

The absence of interdental contacts causes permanent injury to the gingival papilla and, as a consequence of the injury, an inflammatory process. Mechanical injury to the gingival margin is also possible in the absence of the anatomical equator of the tooth crown due to abnormal development or position of the tooth. Teeth crowding is usually accompanied by gingivitis. The inclination of the tooth leads to the fact that on the side opposite to the inclination (Fig. 143), the equator (clinical) moves towards the gingival margin or disappears.

Knowing the functional purpose of the equator - to remove the food bolus from the gingival margin, it becomes clear why a change in the inclination of the coronal part of the tooth causes the development of gingivitis.

Rice. 143. The direction of displacement of the food bolus with a well-defined clinical equator of the tooth crown (a) and in its absence (b), leading to injury to the gingival margin.

Gingivitis also occurs when artificial crowns are poorly modeled, on which the equator and, consequently, the contact point are not recreated.

Artificial crowns that loosely cover the clinical neck of the tooth, as well as its elongated edge, compress the marginal periodontium, where inflammation develops over time. Tissue swelling that occurs during inflammation aggravates the traumatic effect of a poor-quality crown. The edge of a well-made plastic crown inserted into the gingival sulcus can cause gingivitis, since in the oral cavity, in the gingival fluid, the plastic swells and its edge increases and puts pressure on the mucous membrane. If in the first two cases acute serous gingivitis most often develops, then in the latter case it is chronic.

The use of soldered crowns (Fig. 144) and bridges is a source of injury: pinching of the gingival papilla with solder tightly applied to the gingival edge of the artificial tooth.

Gingivitis can occur due to the influence of an inaccurately created edge of a removable denture. With a deep bite, the cutting edges of the incisors, and sometimes the tubercles of the fangs, injure the gingival margin. Gingivitis that develops while using a removable denture is characterized by serous or hypertrophic inflammation.

Serous inflammation varying degrees severity develops with inaccurate reproduction of the relief of the mucous membrane of the alveolar process on the basis of a removable denture. This is possible in the following cases: 1) when using low-plasticity impression material, which presses (squeezes) the tissues of the marginal periodontium; 2) when taking an impression of a patient who already has gingivitis; 3) as a result of distortion of the relief of the contours of the mucous membrane on the basis of the prosthesis during its fitting - excessive grinding of the base along the boundaries of contact with both the mucous membrane and hard tissues teeth. In the first case, a space is formed between the base and the mucous membrane, which, due to irritation and a kind of “suction” force, leads to hypertrophy of the mucous membrane. In the second case, when the edge of the prosthetic base does not rest on the hard tissues of the tooth and a gap forms between them, the latter also “sucks up” the mucous membrane of the prosthetic bed - hypertrophic gingivitis develops; 4) if damaged during manufacturing and use plaster model relief of the mucous membrane in the area of the gingival margin.

Noted frequent development localized form of gingivitis with cervical caries, wedge-shaped defect, caries under an artificial crown or its decementation. Gingivitis often accompanies diseases of the gastrointestinal tract and hematopoietic system; They also occur during intoxication with salts of lead, bismuth, and mercury.

Diagnosis and differential diagnosis

The diagnosis is made based on clinical picture, the degree of nature and prevalence of the process. Sudden Appearance symptoms, identification of previous symptoms from the anamnesis in the period immediately before visiting a doctor infectious diseases, indicate acute serous gingivitis. A history of complaints of periodic bleeding, cyanosis and congestion, especially in the gingival papillae and marginal gums, are signs of exacerbation of chronic gingivitis.

An acute onset on the 2-3rd day after fixation of a crown, bridge, or filling with localization of the process in the area of the supporting teeth reveals the cause of the disease. If the process is also widespread in the area of teeth that have not undergone orthopedic interventions, it is difficult to differentiate traumatic gingivitis from acute gingivitis of another etiology, which is an independent nosological form. It cannot be ruled out that the fixation of the prosthesis coincides with the development of gingivitis of various etiologies. It should also be remembered that fixation of both fixed and removable dentures in the oral cavity in patients with chronic gingivitis, as a rule, leads to an exacerbation of the disease.

Difficulties often arise when deciding whether chronic gingivitis in a given patient is an independent nosological form or one of the symptoms of other diseases, in particular periodontitis, peptic ulcer disease, gastritis, diabetes.

Swelling of the gums in severe gingivitis can mimic a periodontal pocket. Therefore, in order to differentiate gingivitis from periodontitis, it is necessary to carry out

X-ray examination. With gingivitis, no changes in bone tissue are detected. In severe cases, if the presence of general somatic diseases is suspected, a request to the district clinic is necessary.

Establishing the diagnosis and etiological moment of the focal form of gingivitis, which developed as a result of the lack of approximal contacts, abnormal tooth position, and crowding of teeth, is not difficult. The presence of tartar indicates a chronic process.

In case of focal gingivitis and the presence of artificial crowns, it is necessary to find out and differentiate all possible causes that led to the development of the disease.

First of all, the correctness of the reconstructed anatomical shape and especially the presence and severity of the equator are established. Then, using a probe, the accuracy of the fit of the edge of the crown to the neck of the tooth, the depth of its immersion, and the presence of cervical carious cavities are determined.

With an elongated crown edge, in the elongation zone there are roller-like compactions of the gingival edge and a false gingival pocket. An attempt to reach the edge of the crown with a probe is unsuccessful and causes severe pain. A survey of the patient allows us to establish that when fitting the crown(s), pain was felt, which was repeated when the prosthesis was fixed with cement.

With a wide crown, the gingival margin is loosened, and the edge of the crown is determined with a probe. When transferring the probe from vertical position in a horizontal position and moving it towards the tooth, a distance greater than the thickness of the crown is determined (Fig. 145). Painful sensations, if the crown is wide but not long, it is not observed during fitting. The phenomena of inflammation after fixation of crowns occur after several days or even weeks.

If there is cervical caries under the crown, the swollen gingival margin can be pulled away from the crown and its edge can be seen.

Advancement of the probe and its movement make it possible to determine the size of the cavity.

Treatment

Treatment of gingivitis of traumatic origin should be comprehensive. Due to the variety of reasons, medical tactics require strict individualization. In case of incorrect position of the tooth (Fig. 146, a), crowding of teeth as a result of abnormal development of the jaw, depending on age, orthodontic treatment methods or various types of artificial crowns are used. Orthodontic methods for correcting the position of individual teeth (mild crowding of teeth) are effective up to the age of 30 years. They are indicated if the movement of teeth does not require significant restructuring of the length of the dental arches and occlusal relationships throughout the entire dentition. At the same time as orthodontic procedures, medicinal treatment of gingivitis is carried out. If there is no space in the dentition for a tooth to be moved and in people over 30 years old, orthopedic devices are used. Before making them, it is necessary to carry out therapeutic treatment until all inflammatory phenomena are completely removed, otherwise the artificial crown after its fixation will become short, as tissue swelling will disappear.

When tilting teeth, rotating around an axis effective means is an artificial crown that restores not only the aesthetic norm, but also the correct position of the tooth in the dentition. If the tooth is inclined, the preparation should be changed: more healthy tissue is removed from the inclined side so as not to expand the occlusal surface (Fig. 146, b).

For gingivitis or papillitis resulting from trauma to the gingival papilla, the use of a cast inlay or crown with precise restoration of interdental contacts is indicated. Traumatic gingivitis that develops as a result of an incorrectly made crown is treated with medication, but first of all it is necessary to remove the crown or group of crowns, which will eliminate the cause.

Before repeated prosthetics, the quality of the previously performed preparation is carefully assessed and, if necessary, appropriate adjustments are made.

The presence of a carious process in the cervical area, depending on the length of the cavity, requires a change in tactics complex treatment. When the cavity spreads on one or two surfaces of the tooth, the process penetrates under the gingival margin, the use of a metal tab or filling the cavity with amalgam is indicated (the use of plastics and even composites is contraindicated). In cases of hypertrophic gingivitis, preliminary excision of the gum area or its electrocoagulation is indicated. The cavity in the tooth must be closed. The manufacture of inlays and crowns begins after complete removal of inflammatory phenomena. To accurately determine the relief and level of immersion of the crown edge, the use of a two-layer impression is recommended.

The development of circular caries and necrosis of hard tissues as a result of decementation of crowns serve as an indication for tooth depulpation (regardless of subjective data and indications of electroodontodiagnosis). After this, the coronal part is excised, a stump with a pin and an artificial crown are made (stump crown according to Kopeikin).

In case of persistent gingivitis that is not amenable to drug therapy, especially in cases of incorrect tooth position or the presence of cervical caries, temporary crowns are made. In these cases, it is advisable to bring the crown edge to the level of the gingival margin. After the gingivitis is cured, they switch to a permanent structure.

Traumatic gingivitis that has developed in the group of anterior teeth, with a deep bite, is treated by grinding the incisors, and sometimes the canines in the lower jaw. In severe cases, it is permissible to depulp these teeth with subsequent grinding (shortening) of the crown part of the tooth. Grinding must be carried out in such a way as to maintain occlusal contacts on the group of anterior teeth.

Prevention

To preventive measures to prevent the development of gingivitis traumatic origin, should include: 1) timely, in childhood, treatment of anomalies in the position of teeth and jaw development; 2) creation of contact points when filling carious cavities on the contact surfaces of the tooth. It is preferable to treat with tabs; 3) the use of cast inlays in the treatment of cervical caries, less often - composite materials (plastic fillings are contraindicated); 4) strict quality control of artificial crowns: restoration of the anatomical shape of the tooth (especially the quality of the recreated equator), the length and width of the cervical part of the crown. Only the metal frame of the crown can be inserted into the dental sulcus; the facing material is brought to the gingival edge, without overhangs over it. In the long term preventive value acquires a refusal to use crowns made of acrylic plastic, stamped crowns, including crowns with Belkin veneering.

For warning repeated diseases marginal periodontal after a naturally high-quality orpedic stage of treatment, great importance is attached to oral hygiene.

To prevent the development of gingivitis when using removable dentures, taking impressions for the manufacture of dentures is permissible only after complete elimination of inflammation in the marginal periodontium. An equally important preventive measure is the use of clasp dentures instead of plate ones, naturally, in accordance with medical indications. If plate prostheses are indicated, then precise adherence to the boundaries of the prosthesis, the degree and level of its adherence to hard tissues is also a measure to prevent gingivitis.

Orthopedic dentistry
Edited by Corresponding Member of the Russian Academy of Medical Sciences, Professor V.N. Kopeikin, Professor M.Z. Mirgazizov