Gum disease is a group of diseases characterized by damage to the gum tissue. Patients complain of hyperemia, swelling of the gums, bleeding during cleaning. Hypertrophic gingivitis causes hyperplasia of the gingival margin. In the case of ulcerative-necrotic gum diseases, lesions covered with a gray-green coating are detected. The interproximal papillae gape. The diagnosis of gum diseases is reduced to the collection of complaints, the compilation of anamnesis of the disease, the conduct of clinical and X-ray studies. Treatment includes sanitation of the oral cavity, elimination of local irritating factors, increase of local and general resistance of the body.
Meaning
Gum disease is an inflammation of the gingival margin of infectious (bacterial, viral, candidiasis) or traumatic origin, occurring without violating the integrity of the dental epithelial attachment. A marked increase in the prevalence of gum disease occurs during puberty, which is associated with a change in the hormonal background in adolescents. Studies have shown that after 60 years, the frequency of gingivitis diagnosis reaches 100%. Gum diseases are more common in males, which is explained by an unsatisfactory level of hygiene, the presence of bad habits. Prognostically, with timely comprehensive treatment of gum diseases, it is possible to completely stop inflammation, prevent the involvement of periodontal tissues in the pathological process.
Causes
The main local causes of gum disease are hard and soft dental deposits. Due to the toxic effect on the gum tissue of the waste products of microorganisms that make up the dental plaque, a catarrhal form of gingivitis develops. There are also gum diseases of viral, mycotic, bacterial (fusospirochetous) genesis. Mechanical, thermal and chemical stimuli can provoke the development of inflammation with a predominance of the exudative component. Productive hyperplastic processes occur with progesterone-dependent gingivitis. This form of gum disease occurs mainly during puberty, during pregnancy, as well as when taking hormonal drugs.
Forced orthodontic treatment with the use of high forces also causes gum hyperplasia. Along with primary inflammation, secondary (symptomatic) gum diseases are distinguished, manifested in hypovitaminosis, endocrine disorders, blood diseases, pathologies of the digestive system. Local predisposing factors contributing to the development of gingivitis include malocclusion, crowding of dentition. In the acute course of gum disease, the tissues become edematous, hemorrhage zones appear. Inflammatory infiltrate cells are concentrated around blood vessels: lymphocytes, histiocytes. Microscopically, in chronic gingivitis, the maturation of granulations, the replacement of collagen fibers with coarse connective tissue is observed. Accumulations of leukocytes are represented in insignificant numbers.
Classification
In dentistry, there are three groups of gum diseases:
- Gum diseases provoked by pathogenic microflora of dental plaque. This category also includes symptomatic gingivitis, indicating the presence of background somatic pathology.
- Gum diseases of traumatic or infectious etiology (caused by herpes simplex viruses, yeast fungi). Gingivitis of iatrogenic origin is also distinguished, which develops when the protocol of treatment of patients is violated.
- Ulcerative-necrotic gum diseases. They occur against the background of reduced local and general reactivity of the body due to the activation of a microbial association consisting of fusobacteria and spirochaetes. Vincent’s gingivitis is more often detected in men under the age of 30.
According to the localization of inflammation, lesions of the interproximal papillae, marginal margin and alveolar gum are distinguished. According to the prevalence, the pathological process can be localized or generalized.
Gum disease symptoms
With catarrhal gingivitis, the gum becomes painful, edematous, hyperemic. Often patients complain of bleeding when eating hard food or while brushing their teeth. Gum diseases that occur with a predominance of the productive component are accompanied by an overgrowth of the gingival margin. The marginal gum acquires a roller-like shape. There is an unpleasant smell from the mouth. With ulcerative-necrotic diseases of the gums, damage to the interdental papillae is detected. With the progression of the inflammatory process, the necrosis zone extends to the marginal part. During the examination, necrosis of the gingival margin is detected. When trying to remove a dirty gray plaque, a bleeding painful surface is exposed. The general condition of patients with ulcerative-necrotic gum diseases worsens. There is hyperthermia, sleep disorder, lack of appetite. Regional lymph nodes are enlarged.
The desquamative form of gingivitis proceeds with the formation of areas of peeling of the epithelium against the background of inflamed gums. If the cause of gum disease is a herpetic infection, during the incubation period there is a burning sensation of the mucous membrane. During the next 1-2 days, bubbles appear on the mucous membrane, which open very quickly, resulting in erosion. In severe form, repeated sprinkling of lesion elements occurs. Upon examination, it is possible to identify not only bubbles, but also erosion, crusts. There is an increase in temperature, regional lymphadenitis.
With mycotic gum diseases, a whitish plaque is found on the mucous membrane, which is easily removed with a spatula or a cotton ball, but appears again within a short period of time. Patients are concerned about itching, burning, dryness of the mucous membrane. In case of mechanical damage, an erosive area forms on the gum. When exposed to the thermal factor, desquamation of the surface epithelium occurs. It is also possible to reject gum tissue with the formation of an ulcerative surface. Gum diseases that develop as a result of mucosal contact with alkali occur with the formation of a zone of colliquation necrosis. The lesion area extends both in depth and in width. Coagulation (dry) necrosis is observed when exposed to acids.
Diagnostics
The diagnosis of gum diseases is reduced to collecting complaints, compiling anamnesis, conducting a clinical examination and additional research methods. During a physical examination for gum diseases, swelling and hyperemia of the gingival margin are detected. With hypertrophic gingivitis, the dentist detects thickening and overgrowth of the gums. With ulcerative-necrotic gum diseases, gray-green layers are determined, which cover the marginal part of the gum. When the plaque is removed, a painful bleeding erosive surface is exposed.
In most cases, the Fedorov-Volodkina hygiene index in patients with gum diseases is unsatisfactory. On examination, multiple supra- and subgingival deposits, carious defects are noted. The Schiller-Pisarev test for gum diseases is positive. Staining of the gum tissue in yellow-brown color after application of iodine-containing drugs confirms the development of the inflammatory process. With the help of the PMA index, the level of lesion is determined. With inflammation of the interproximal papillae, the value of the indicator is 25%, with involvement of the marginal edge of the PMA in the pathological process – 50%. In the case of gum diseases accompanied by damage to the alveolar part, the value exceeds 50%. Virological test, immunochemical and cytological analyses are indicated for the diagnosis of herpetic infection.
Mycotic etiology of gum diseases is established by bacterioscopy. The detection of budding cells and pseudomycelia filaments in the smear confirms the development of candidiasis gingivitis. Unlike periodontitis, there are no destructive changes in bone tissue in gingivitis on the X-ray. Differentiate gum diseases with inflammatory and dystrophic periodontal diseases. The patient is examined by a dentist-therapist. If the development of symptomatic (secondary) gingivitis is suspected, consultations with a therapist, hematologist, endocrinologist, gastroenterologist are indicated.
Gum disease treatment
Treatment of gum diseases is aimed at eliminating microbial contamination, accelerating regeneration processes. For this purpose, the oral cavity is sanitized – professional hygiene procedures, treatment of caries and its complications. In case of irrational prosthetics, repeated orthopedic treatment is indicated. Locally, for gum diseases, oral rinsing is prescribed with antiseptic solutions based on chlorhexidine bigluconate. Decoctions of medicinal herbs have good anti-inflammatory activity. The treatment of ulcerative-necrotic gum diseases consists of the following stages: anesthesia, antiseptic treatment, removal of necrotic tissues, stimulation of epithelialization processes.
Gingivectomy is performed for gum diseases accompanied by hyperplasia. Etiotropic therapy of herpetic lesions includes the use of antiviral drugs that are active against intracellular viruses. General treatment includes immunomodulators, desensitizing agents, multivitamin complexes. In case of gum diseases of mycotic nature, antifungal drugs are prescribed. With gingivitis of traumatic origin, rinsing of the oral cavity with antiseptic solutions is indicated, as well as the use of keratoplastics in the form of applications. The prognosis for gum diseases is favorable. With early detection and complex treatment, it is possible to stop inflammation, prevent the involvement of periodontal tissues in the pathological process.