Gingivitis (inflammation of the gums) - types and forms (catarrhal, hypertrophic, ulcerative, necrotic, acute and chronic), causes of the disease, symptoms (smell from the mouth, pain, bleeding, etc.), diagnostic methods, photo. Interdental papillae and problems with

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 normal anatomy and physiology of the oral mucosa, the ability to explore 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. In the epithelial layer there are cells of 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 features 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 the connective tissue of the shell itself, small blood vessels such as capillaries and nerves are laid. 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) - a survey, 2) examination, 3) palpation - palpation, 4) microscopic examination. 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 laboratory 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). With the defeat of the back of the tongue, the pronunciation of the sounds "g" and "k" is especially affected.

In case of violations of the integrity of the hard palate (syphilis, congenital fissure defects, injuries) and if the soft palate is damaged, even slightly, 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 of the functional study of the mouth into the survey.

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 for general infectious diseases, diseases of the digestive system, metabolism.

In acute cases, it is important to determine the presence of any acute common infection, for example, the flu. 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 of the 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 of the surface layers, abundant blood supply due to the presence of a dense vascular network, the absence hair follicles And sweat glands, a small number of 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, determine 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 from under the mucous membrane, thin superficial veins 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 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 of the 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 of the 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. The excretory ducts of 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 tongue, even in its normal state, 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 in hemiplegia, trigeminal neuralgia, 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. Here the follicular apparatus of the tongue is laid and, due to the presence a large number crypts (bays), this part in appearance resembles an amygdala. 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 lymphatic system organism.

When examining the lateral surface of the tongue at its root, rather thick venous plexuses, which sometimes may 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 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 the frenulum of the tongue, there 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 normal view. 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. In 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) - a 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 it. 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 papule is based on the proliferation of cellular elements in the papillary and subpapillary layers, accompanied by an expansion of the superficial vessels. Papular rashes on the mucous membrane are observed mainly in inflammatory processes [syphilis, 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 captures all layers of the mucous membrane. Due to this, the tubercle, unlike the papule, leaves a trace in the form of an atrophic scar during reverse development. 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 anterior region. upper teeth. Lupus erythematosus (lupus erythematodes) has a favorite localization on the oral mucosa - this is mainly the red border of the lips and the inner surface of the cheek 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 caused very often or by phlegmonous inflammation 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 ulcer on tongue, cheek, lip.

A cancerous ulcer is characterized by the presence of a very dense cartilage in consistency, a rim around the ulceration. Feeling cancerous ulcer painlessly. 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 of inflammatory and blastomatous processes. Lymph from the soft and hard tissues of the mouth is drained through the following system of 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 in the following way. 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. The back of the gums of the lower jaw 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. 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 from the 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. The facial lymph nodes are located mainly on the buccal muscle in the space between the masticatory and circular muscles of the mouth. 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.

If the interdental papilla hurts, you should determine the type of disease that caused the inflammation process.

Gingivitis

This is inflammation of the gums without violating the integrity of the gingival junction. Allocate the following types gingivitis:

1. - swelling and redness of the gums. A person feels pain and itching in the affected area, especially after eating.
2. - the appearance of ulcers. Manifested by pain and.
3. - the papillae increase in size and become red. They can partially close the tooth and, in the absence of treatment, begin.
4. - the papillae reduce their size, due to which the dental ligaments are exposed.

With timely treatment to the dentist, gingivitis disappears in 7-10 days. In the absence of acute pain and discharge of pus from the gums.

It may be of the following type:

• - the lesion occurs in the region of the root system;
• marginal periodontitis - the gum is affected, most often in the interdental space.

The disease can progress without visible symptoms and lead to complete loss of the tooth, infection of adjacent tissues. The disease may also acute symptoms and manifest itself in the form of small formations on the papillae with pus inside.

fibromatosis

- This is a tumor-like lesion of periodontal tissues, which is manifested by hypertrophy of the gingival margin, papillae or the entire alveolar gum.

Most common in humans young age. It is often detected in children during the period of temporary or permanent teeth. The symptoms are seen predominantly in women.

Treatment of gingival fibromatosis consists in surgical excision of the overgrown gums.

Inflammation of the gums is a fairly common disease that occurs in both adults and children. Many people today complain about hypersensitivity and bleeding gums. When the gums become inflamed and bleed, the mood falls "below the baseboard." And there is a reason why. Not only does a smile with inflamed gums look, to put it mildly, unattractive. So, more and painful sensations, and smell from the mouth. AND toothache may happen. Why is there a good mood here? And just as you think that inflammation of the gums can lead to loss of teeth, the melancholy overcomes.

Inflammation of the gums

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

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

The reason may be damage to the mucous membrane when eating, brushing your teeth, traumatic installation of fillings, prostheses, crowns or braces. May appear 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 accompanying underlying disease, which should be treated first.

Also found gingivitis of pregnant women, which may be accompanied by swelling of the gums, bleeding, the appearance of pus and the smell 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 flowing pus, the bone around the teeth atrophies, periodontitis penetrates the bone, and the roots are exposed. If not carried out timely treatment over time, the teeth will fall out.

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

periodontal disease

Periodontitis occurs as a result little or uneven load on the teeth. It is accompanied by a little bleeding, usually without pain, and a small amount of tartar. It develops slowly, but if left untreated, it leads to periodontitis. Most often occurs in older people.

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

If the gums swell with periodontitis, which is caused by an infection in the canals of the tooth, it is useless to treat the inflammation of the gums. Necessary fill root canals.

In case of gum injuries as a result of incorrect, traumatic installation of fillings, crowns, prostheses or braces, you should first contact your dentist to eliminate the cause. Without this, gum treatment will not be effective.

Causes of inflammation of the gums

Usually distinguish internal and external causes inflammation of the gums. External causes as a result of impact include:

• poor or no oral hygiene, or improper care behind her;
• the presence of tartar;
• improper installation of fillings, dental crowns, braces prostheses;
• malocclusion;
• smoking.

The internal reasons are:

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

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

Treatment options at home

Gum disease can be treated in a variety of ways. 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 severe cases, the doctor will prescribe a treatment that is combined with additional home remedies. provide a good effect.

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

Speaking about ways to treat gums at home, there are medicinal products pharmacy (medication) and folk.

Pharmacy funds

Pharmaceutical products include rinses, sprays, applications, toothpastes and gels. All pharmaceutical preparations are supplied with instructions for use, which must be observed and followed by the recipe for admission 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.

With bleeding and inflammation of the gums, various pharmaceutical products, which stop inflammation, anesthetize, eliminate bleeding, itching and burning, relieve swelling and disinfect the mucous membrane from microorganisms and bacteria.

Antiseptic rinses include:

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

The effect of rinsing treatment can be enhanced by using compresses and applications in parallel. medicinal pastes, gels and ointments.

Healing gels and ointments form a protective film on the mucosa. 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 medicinal herbs and anti-inflammatory ingredients. For inflammation of the gums, it is recommended to use toothpastes:

Folk remedies for treatment

In order to get a really positive therapeutic effect and the disease has not progressed, before deciding how to treat inflammation of the gums at home, it is recommended to consult a specialist not only to establish a diagnosis, but also, if necessary, to clean, remove tartar and get basic appointments.

Typically, the application 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 the absence 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 therapeutic applications.

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

With simple inflammation, rinsing with a decoction or infusion may be enough. But herbal infusions stored for a short time, it is advisable to cook them daily. Most effective and safe sage, burnet, yarrow, chamomile, calamus, oak bark, sorrel, St. John's wort, lime blossom, calendula, eucalyptus and many others.

Below are a few of the most simple recipes gum treatment home remedies.

First aid for inflammation of the gums

In case of severe pain, for the treatment of gums at home before visiting a doctor, it is recommended to rinse the mouth with solutions:

• potassium permanganate;
• drinking soda;
• chlorhexidine;
• furatsilina.

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

The main thing is not to resort to radical methods of self-treatment, as this can cause more serious consequences. In order to stop the spread of inflammation, it is best to apply various infusions with antimicrobial activity. Pharmacies sell these without a prescription. highly effective means, like "Stomatidin", "Mevalex" and "Givalex". They should be used according to the instructions included in the package.

The beauty of the teeth depends on the condition of the gums. With inflammation of the gingival tissues that fill the interdental spaces, many uncomfortable and alarming signs appear, leading to the development of serious pathological processes in the oral cavity.

A person should immediately seek help from a specialist, as the ongoing disease can aggressively affect the integrity of the dentition.

Also, dentists strongly advise to use regularly preventive measures that help reduce the risk of inflammation of the sensitive and vulnerable part of the soft tissues.

General view

Interdental papillae are areas of gum tissue located between the teeth. They protect the root system of each of the units, prevent the accumulation of food particles, which decompose over time and infect the oral cavity with pathogenic bacteria.

Interdental papilla (papillae) is a dense connective tissue which is covered by oral epithelium.

In appearance, the interdental papillae resemble pyramids that fill the spaces between the incisors. Healthy interdental tissues have a light peach color. They fit snugly to the surface of the units, leaving no gaps. Their shape and size are proportional to the teeth.

When inflamed, the papillae may recede from the teeth, forming a black triangle. The pathological process contributes to the development of edema, pain and bleeding.

The papilla, like all gum tissue, is unable to regenerate and grow back. If its integrity is broken due to rough hygienic cleansing or exposure of tooth roots (recession), then this pathological course cannot be reversed.

Causes of deviations from the norm

More often, negative changes in the structure of interdental soft tissues occur due to poor hygiene care. Illness of the papillae negatively affects the condition of the dental units.

For this reason, contacting a specialist when signs of the disease appear in the form of tissue edema and redness is mandatory. The doctor will diagnose and prescribe the correct treatment.

Pathology can occur for several reasons. Consider the common factors:

• bad habits (smoking, alcoholism);
• lack of useful trace elements in the body;
• hormonal disbalance;
• infectious diseases;
• diseases of the digestive system;
• pathology of the cardiovascular apparatus;
• decrease in protective functions in the body;
• long-term drug therapy with drugs of certain groups.

Local factors can also have a detrimental effect on soft structures oral cavity. The list compiled by experts is as follows:

• thermal or chemical burn;
• mechanical injury;
• hardened plaque;
• poor oral hygiene;
• teething phase;
• unsuccessful restoration of the integrity of the dentition with the help of prostheses.

Remember! Negative impact the condition of soft tissues can be affected not only by the above factors, but also by the sharp edges of the crown or filling material.

In this case, the pathogenic factor can cause disturbances only at the site of injury to the gum tissue.

Symptoms

A progressive pathological process can be recognized by the presence of edema and redness of soft structures.

If treatment is not started on time, negative changes in the tissues will cover more areas and provoke bleeding gums, unpleasant sensations of irritation.

In advanced cases, there may be structural changes papilla The increased volume of tissues covers the tooth by almost half of its entire crown part. This entails the occurrence of pain during meals, as well as discomfort and difficulty during chewing.

The main manifestations of pathology are as follows:

• accumulation purulent exudate in the gaps between the teeth;
• bad breath;
• gum hyperplasia;
• the occurrence of pain in the process of chewing food;
• darkening of the damaged mucosa;
• hyperesthesia of the teeth (acute sensitivity to various stimuli);
• diffuse changes in the structure of soft tissues.

Remember! Delayed treatment can lead to the development various pathologies in the oral cavity, which entail significant destruction of soft and hard structures.

Gingivitis and periodontitis

The progressive course of the pathology can lead to an inflammatory process that develops against the background of intensive reproduction of bacteria in the oral cavity.

The pathological condition often leads to tooth decay due to changes in the density of surrounding tissues. With such a clinical picture, doctors diagnose gingivitis (gum disease).

As a rule, this disease, subdivided into types, is a precursor of periodontitis.

Catarrhal gingivitis

Statistically, given form diseases are more common. You can recognize it by the following manifestations of the body:

• bleeding gums;
• excessive accumulation of fluid in the gum tissue;
• inflammation of the mucosa, causing redness;
• unpleasant feeling of irritation;
• appearance bad smell and the taste of rot;
• growing pain syndrome in the process of eating;
• deformation of the outlines of the gums;
• general weakness.

The stage of development of the disease can be mild, moderate and severe. The complexity of the case depends on the location of the affected area in the oral cavity and the intensity of the symptoms.

Ulcerative gingivitis

In some cases, inflammation of the gingival papilla can provoke the development of ulcerative gingivitis. This disease is considered a complex form of the course of the pathological process in the interdental spaces..

Erosive, ulcerative and necrotic manifestations appear on the gums, which can affect both the surface of the mucosa and deeper layers.

The symptoms of the disease are as follows:

• dirty gray plaque on the periodontal tissues;
• bleeding gums;
• increased body temperature;
• unnatural lightening of the skin of the face;
• lack of appetite.

It is not worth self-medicating with ulcerative gingivitis, since improperly selected therapy can provoke the occurrence purulent inflammation which will lead to serious health problems.

Hypertrophic gingivitis

This disease is characterized by chronic inflammation of the gum tissues and is accompanied by an intense increase in their volume.

The gingival papillae grow and cover the crowns of the teeth by a third from the outside and from the side of the tongue. In terms of density, the gum remains hard, and under it, on the surface of the units, tartar is formed.

Symptoms:

• keratinization and thickening of soft structures;
• darkening of the mucosa;
• increase in the density of gum tissue;
• soreness even with a light touch to the affected area;
• difficulties in the process of eating.

More often, the disease develops against the background hormonal disruptions or problems in the metabolic processes of the body.

Periodontitis

Clinical picture this disease expressed in the presence of inflammation near the apex of the tooth root. At the second stage of the disease, the inflammatory process affects the edge of the gums.

The progression of the pathology leads to the resorption of bone tissue. The formed cavity is filled with granulation tissue. As a result, for the release of pus to the outside, a fistula is formed or a cyst is formed.

A cystic element can be temporary - it suddenly disappears, and after a while reappears.

The reason for the development of periodontitis lies in untimely treatment pulpitis or poor-quality filling of the canals of the root of the tooth.

Inflammation during pregnancy

During the gestation period hormonal background women endure major changes. At this stage protective functions organisms are reduced, the risk of developing various diseases in the oral cavity.

If treatment is not started in time, the pathology will begin to spread at a high speed, which will lead to poor health in general and negative effects on the fetus.

Incorrect therapy or its absence can provoke an abortion or disrupt the process prenatal development baby.

Influence of orthopedic constructions

A poorly installed prosthesis or crown can become a provocateur of the development of pathology. Insufficient fitting of the structure leads to injuries of soft tissues and mucous membranes. Inflammation develops in the affected areas.

In the absence of proper treatment, periodontal pockets form in the spaces between the teeth, which become an ideal environment for the accumulation of pathogens. . Such clinical picture difficult to treat.

Teething

Gingival papillae often become inflamed during the eruption of wisdom teeth. If the condition is not aggravated by various factors, the patient has only swelling and minor pain.

Pain can be reduced with analgesics, however, dentists recommend resorting to professional help, due to high risk development of purulent-necrotic process.

Specialist consultation

To assess the patient's condition, and to understand what problem he had to face in the oral cavity, the specialist performs a visual examination.

Having recognized the pathology and the severity of its course, the doctor performs a complete sanitation of the oral cavity. Hard deposits on the teeth are removed using ultrasonic waves.

To make the surface of the teeth smoother, the specialist resorts to polishing procedures., which will help reduce the chance of plaque formation, including food residues and pathogenic bacteria.

Methods and tactics of treatment

The determination of therapeutic measures is the task of the specialist only. Complex medical measures aimed at suppressing the pathology depends on the disease, its course and degree of development.

Anti-inflammatory therapy

In dental practice, application therapy and antiseptics relieve inflammation well. When diagnosed with gingivitis, doctors often prescribe Chlorhexidine rinses.. Holisal-gel also proved to be excellent.

In the case of periodontitis, treatment should be comprehensive. A mini-surgery is performed followed by antibiotic therapy with drugs from the group of antibiotics.

Methods of treatment of pregnant women practically do not differ from the health measures used in relation to ordinary patients. the only distinguishing feature- the choice of approved drugs that ensure the safety of mother and child.

Antibiotic therapy

At severe course gingivitis or disease caused by bacterial agents, without antibacterial drugs not enough.

More often doctors prescribe the following means:

• Augmentin;
• Klindamitsyn;
• Wilprafen;
• Macrofoam.

The choice of the most appropriate remedy for a particular clinical case remains with the attending dentist. The dosage and frequency of receptions is also determined by the physician.

Preventive measures for the development of dysbacteriosis is the appointment of prebiotics and vitamins.

Surgical intervention

The most common method in surgical dentistry- this is coagulation, used not only for treatment, but also for plastics of gum tissues and mucous membranes. Thanks to innovative technologies excisions are carried out using electrodes.

In fact, the operation consists in cauterization of the affected areas. Instrumentation for the operation is heated by electricity. Diathermocoagulation of gum tissue is carried out with a high-frequency alternating current wave.

If the operation is successful, the wound area should turn white. First of all, alternating current affects the vascular network and accelerates the rate of blood clotting.

Minor damage to the vessels allows them to close quickly, which prevents further bleeding.

This operation makes it possible in a matter of minutes disinfect the wound on the gingival papilla, eliminate the signs of the inflammatory process and heal the affected tissues.

Treatment for injury

If the development of the inflammatory process on the gum was provoked by an injury caused by the overhanging edge of the frozen filling material, the first health care consists in sawing off interfering elements or a complete replacement of the seal.

In case of incorrect installation of a prosthesis or crown, doctors eliminate inflammatory symptoms drug therapy.

Usually, the treatment program is almost identical to the methods for eliminating gingivitis. Depending on the result, the doctor considers the need to remove prosthetic structures until the soft tissues are completely restored.

Rules for choosing care products

The inflammatory process on the gingival papillae can be quickly eliminated if the problem is comprehensively approached. In addition to drug therapy, it is important to scrupulously observe the rules of hygiene.

An important point in proper care of all tissues of the oral cavity is choice of toothpaste and brush. When purchasing a cleaning agent and care device, you need to pay attention to the following:

• the composition of the toothpaste plays an important role, so it is better if it includes components of medicinal herbs that effectively relieve inflammation of any kind;
• ingredients based on antibacterial substances, such as trilosan, will not be superfluous in the composition of the paste;
• daily care of teeth and gums requires not only a therapeutic effect, but also the adoption of preventive measures, so the paste should have not only a therapeutic, but also a preventive effect;
• to reduce the likelihood of injury to the mucous membranes and gums, the brush should be with a bristle of medium hardness.

The toothbrush is changed every 5-6 weeks. Compliance with this important rule enable you to protect yourself from possible complications and accelerate the healing and recovery processes.

Prevention measures

Preventive measures aimed at the health of teeth and gums are as follows:

• eating a large amount of seafood, greens, dairy (such food is rich in calcium, which strengthens inert tissues);
• conducting healthy lifestyle life (rejection of bad habits is required);
• compliance with the rules of healthy eating;
• meticulous and meticulous care oral cavity(brushing teeth in the morning and evening, flossing after each meal).

The acute stage of inflammation of the gingival papillae requires careful planning of treatment, so it is important not to start the disease, but to resort to preventive measures in time.

They will help reduce the likelihood of developing pathology and the appearance of unwanted uncomfortable symptoms.

The video presents Additional Information on the topic of the article.

An inflammatory process that affects the gingival papillae and the gingival margin, interspersed with exacerbations / remissions, is called chronic gingivitis. The disease is manifested by congestive swelling of the surface of the gums, increased bleeding and deformation of the gums. The pathology is also characterized by an unpleasant smell of breath.

The diagnosis is made on the basis of visual inspection and medical records. Treatment of the chronic form of inflammation is to perform professional cleaning teeth, sanitation of the oral cavity with antiseptic solutions, etc.

Causes of the disease

Gingivitis that has passed into a chronic form, as a rule, is the result of poor-quality or incomplete treatment. acute form pathology. That is why chronic gingivitis develops for the same reasons as its acute form.

They should include:

Disease classification

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

• infectious;
• thermal;
• chemical;
• traumatic;
• caused by hormonal disruptions;
• allergic.

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

• Localized. If inflammation of the interdental papillae is diagnosed, then we are talking about papillitis. With inflammation affecting the gingival margin, we can talk about marginal chronic gingivitis.
• generalized form. Here, the inflammation spreads to the entire surface of the gums.

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

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

Symptoms of chronic inflammation

Gingivitis in the chronic form, as well as acute gingivitis, has a characteristic symptomatology:

Varieties of chronic gingivitis

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

• catarrhal;
• hypertrophic;
• atrophic.

Chronic catarrhal gingivitis

The disease in this case is a reaction to the negative influence of microorganisms present in the bacterial plaque on the surface of the 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 surface of the gums.

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

Advice! Chronic catarrhal gingivitis is diagnosed mainly in childhood and in young people 25-30 years old. Wherein general well-being the person remains unchanged.

Diagnosis of pathology

Diagnosis is based on visual examination. The doctor notes the presence of tartar and signs chronic inflammation gums - hyperemia and swelling. For the disease, the formation of periodontal pockets is not typical. And the teeth remain in their original places, not shifting.

Treatment of the disease

Treatment of chronic pathology involves the following steps:

Advice! The basis of the treatment of catarrhal gingivitis, which occurs in a chronic format, is high-quality oral hygiene.

• In severe cases of the disease, antibiotics are prescribed.
• Excellent results are obtained by the use of physiotherapy procedures.

Chronic hypertrophic gingivitis

This form of pathology is characterized by long-term inflammation, accompanied by growths of gum tissue. Resolution of the dentogingival connection is not observed.

The main symptomatology of the disease

A key sign of pathology is an increase in the volume of the gums. But besides this, there are other bright symptoms:

• severe pain accompanying touching the inflamed surface;
• bleeding that accompanies even light touches of the damaged gums;
• pain when eating (this is especially true for hot, spicy and salty foods);
• an increase in the volume of gum tissue causes difficulties in eating, interfering with its quality chewing.

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

• granulating gingivitis;
• fibrous pathology format.

For granulating hypertrophic gingivitis the following manifestations are typical:

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

Advice! Granulating gingivitis most often affects large areas of the gums.

In the fibrous course of hypertrophic gingivitis, the following conditions are observed:

• increased gum density;
• absence of painful sensations, the surface often retains its usual color;
• there is no bleeding;
• gum volume increases slightly;
• deformation is observed only in the places of the course of the pathological process.

The growth of the gums is determined by three degrees:

• In the first degree, the gingival margin becomes slightly thicker.
• For the second degree, an increase in papillae is typical.
• At the third degree, a significant growth of the gingival margin and gingival papillae is diagnosed. Visually, the gums take the form of a dense roller 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. Procedures are performed in the dentist's office. And only after that, treatment can be selected based on the type of hypertrophic gingivitis:

• With severe edema, applications are prescribed to the affected surface. 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 top of the gingival papillae.
• At fibrous form the introduction into the interdental papillae of lidase, previously dissolved in novocaine, is prescribed. In severe cases, it is prescribed surgery(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.

For this form of pathology, in addition to chronic course, characterized by a decrease in the volume of the gums. The reason for this is the drying of the gingival papillae and the edge of the gums. It differs in the localization of inflammation and happens:

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

Chronic atrophic gingivitis is a clear sign of incipient periodontal disease. Periodontal inflammation is quite difficult to treat and has a relapsing course.

Treatment of the disease

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

Therapy of atrophic gingivitis can be performed in two ways:

• conservative treatment;
• surgical intervention.

Conservative treatment involves the following scheme:

• it is necessary to conduct a quality dental sanitation oral cavity (heal carious teeth, removal of tartar and microbial plaque);
• grinding of all sharp edges near the teeth should be carried out (this will reduce the risk of injury to the inflamed gums);
• after the completion of dental procedures, gums are treated with hydrogen peroxide (up to two times a day);
• the use of applications with healing preparations (sea buckthorn or rosehip oil);
• taking vitamin complexes;
• sanitation of the mouth (rinsing) with 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 directed by a doctor.

If improvements cannot be achieved, then it is recommended to carry out surgical intervention. Treatment consists of ginginoplasty, in which the missing gum areas are replaced with healthy tissues taken from neighboring areas.

Diagnosis of chronic gingivitis

The diagnosis is made on the basis of a visual examination:

General treatment of chronic gingivitis

In general, the treatment of pathology is as follows:

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

An excellent result in the treatment of chronic gingivitis gives physiotherapy. An excellent prevention of the disease is regular visits to the dentist's office.