Catarrhal gingivitis - diagnosis and treatment in adults and children. Exacerbation of chronic catarrhal gingivitis - symptoms and methods of treatment Catarrhal gingivitis etiology pathogenesis clinic diagnostics

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

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

The reasons

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

Other factors that provoke catarrhal gingivitis include:

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

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

During teething, signs of gum inflammation are observed for a short time. Usually the disease disappears immediately after the appearance of the crown on the surface. At this time, it is important to provide competent care for the oral cavity of the baby.

Symptoms

The main symptom of a violation is bleeding and a feeling of fullness in periodontal tissues. During the period of exacerbation, a person may feel bad breath, which is not stopped by rinses and pastes.

Other signs characteristic of the acute stage of gingivitis:

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

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

Chronic catarrhal gingivitis develops as a result of illiterate treatment of primary forms of the disease. This form of violation is practically untreatable and recurs during the off-season.

If during the disease there is shakiness of the teeth, then this indicates that catarrhal gingivitis has passed into a more dangerous state - periodontitis

With an exacerbation of chronic gingivitis, patients complain of:

discomfort during eating and hygiene measures;
the appearance of blood during pressure on the gums with a tongue or toothbrush;
enlargement of interdental papillae;
blue gums due to disturbances in their metabolic processes and blood circulation.

Classification

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

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

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

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

Light degree. Only damage to the intergingival papillae is noted.
Medium degree - there is a lesion of the free area of soft tissues (marginal zone).
Severe degree - the pathological process covers the entire alveolar region.

Diagnostics

Only a dentist can make a diagnosis of catarrhal gingivitis after a visual examination. oral cavity patient and diagnostic procedures. To confirm the diagnosis, the dentist uses special tests:

oral hygiene index according to Fedorov-Volodina (the presence of pathological processes is evidenced by an index greater than one);
RMA index;
Kulazhenko test - allows you to determine the areas of development of hematomas in periodontal tissues;
Schiller-Pisarev test. You can talk about the development of inflammation in the gums when positive results samples.

For differential diagnosis, instrumental examination methods are used:

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

Treatment tactics

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

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

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

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

In adults

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

chlorhexidine;
hydrogen peroxide (3%);
Ethonia's solution (1%);
calcium permanganate solution.

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

In the acute stage of inflammation, a solution of glucose or calcium chloride is injected into the interdental papillae. Treatment with injections lasts from 3 to 7 days. Atrophied gum tissue is subject to removal by cryosurgical excision and further cauterization

As an aid to combat pathology, traditional medicine is used:

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

In children

Inflammation of the gums in children is removed with the help of applications based on Solcoseryl and Cholisal. These funds are characterized by a complex action: antimicrobial, analgesic and regenerating. They are safe if accidentally swallowed.

For rinsing the mouth, children are prescribed:

Miramistin;
Chlorhexidine;
Furacilin.

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

From folk remedies children are allowed to use components with low rate allergenicity:

pharmaceutical chamomile;
oak bark;
sage.

To prepare tinctures, take 1 tsp. vegetable raw materials and 200 ml of boiling water. Rinse the child's mouth with the resulting product every 2 hours. To strengthen the affected soft tissues and accelerate their healing. Chewing loads are also recommended, which improve the blood supply to the periodontium.

Fighting exacerbations

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

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

To prolong the action of painkillers and antimicrobial drugs, Deplendent's medicinal film is applied to the gums.

In the stage of active inflammation, it is forbidden to intensively brush your teeth with a brush. Damage to the soft tissues of the gums exacerbates the course of catarrhal gingivitis. During therapy instead of hygiene procedures perform antiseptic rinses. A thorough cleaning of the teeth is started only after the elimination of acute signs of the disease.

Prevention

Regular brushing of teeth (2 times a day) for 3-4 minutes.
Use of prophylactic rinses after completion of standard hygiene procedures.
Flossing after every meal.
The choice of dental care products after consultation with a doctor.
Refusal to consume too hot or cold food.
Introduction to the diet of a sufficient amount of fresh vegetables and fruits. Food rich in fiber naturally removes plaque from the enamel of the teeth.
Getting rid of bad habits.

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

Catarrhal gingivitis is an inflammatory process of the gums, localized in the periodontal tissues (periodontium) and affecting only soft tissues, while the integrity of the connection between the gum and the tooth is not violated.

Children and adolescents are most susceptible to catarrhal gingivitis, with age the risk of the disease decreases or becomes more complex. The course of the disease, depending on the pathogen, can be either acute or chronic.

Causes of catarrhal gingivitis

Catarrhal gingivitis appears under the influence of either local or systemic factors. Among the local ones, the following can be distinguished: poor-quality oral hygiene, especially in cases where there are deposits on the surface of the tooth in the form of plaque or stones, dental intervention associated with dental prosthetics, filling or orthodontic treatment, dislocation or fracture of the tooth crown, malocclusion, non-standard arrangement of the lips, abnormal fastening of the frenulum of the tongue, small vestibule, individual structure of the jaw, when the teeth are crowded and irregularly arranged. In children, a possible cause of the disease is the process of teething, and after the tooth crown comes out of the gums, the inflammation subsides.

In the etiology of catarrhal gingivitis, some general factors play an important role, the impact of which can affect the development of the disease. Some of them are failures in the hormonal system, for example, the period of body restructuring: adolescence, pregnancy, menopause, disrupted work thyroid gland, reception hormonal drugs, as well as the presence of bad habits (smoking). Patients suffering from diabetes and leukemia are at risk and are easily susceptible to catarrhal gingivitis. The disease may develop on the background viral infections weakening all the protective functions of the body. Intoxication with heavy metals, iodine or fluorine can provoke catarrhal gingivitis.

Patients undergoing chemotherapy and radiation therapy are also at risk. Thus, any disorder in the body - chronic or acquired - reduces the protective function of the gums, which allows the development of catarrhal gingivitis. Microorganisms living in the oral cavity, in the presence of any deposits in the form of stones or plaque, begin to produce maximum toxic substances that adversely affect the weakened gums, which causes the pathological process. As a result, inflammation from small areas gradually passes to the entire gum area and its immovable part, after which the full clinical picture development of catarrhal gingivitis.

Classification of catarrhal gingivitis

Catarrhal gingivitis is classified according to the severity of the disease, form and localization. The disease of various forms and stages does not begin suddenly, but progresses, passing from one type to another. The following forms of catarrhal gingivitis are distinguished:

acute catarrhal gingivitis (is a consequence of intoxication of the body, may appear as a result of viral disease- influenza or acute respiratory infections - against the background of weakened immunity, most often diagnosed in the spring and autumn periods);
chronic catarrhal gingivitis (is a consequence of acute gingivitis or may precede it);

Catarrhal gingivitis has the main types of localization - local and general:

localized catarrhal gingivitis affects the gums within one or two teeth;
generalized catarrhal gingivitis affects the entire gum.

Catarrhal gingivitis also differs in the severity of the course of the disease:

mild degree - damage to the papillae of the gums;
medium degree - damage to the part of the gum adjacent to the neck of the tooth;
severe degree - damage to the entire gum, including the fixed part.

Symptoms of catarrhal gingivitis

Acute catarrhal gingivitis manifests itself various symptoms that cause discomfort to the patient, with the disease, pain syndrome appears and discomfort. Among the main symptoms of acute catarrhal gingivitis are the following:

Feeling of sharp pain.
Periodic or constant feeling burning in the affected area.
The presence of itching in the gums.
The appearance of swelling near the lesions.
Bleeding gums.
The mucous membrane of the gums has a pronounced redness.
A significant increase in the size of the gingival papillae;
Presence of soft dental plaque.
Increase in body temperature.
Deterioration general condition.

If, during self-diagnosis, the patient has found one or more symptoms of the disease, it is urgent to consult a dentist. If the treatment is not timely, the disease will turn from an acute form into a chronic one, which has less pronounced symptoms. In addition to the main symptoms of an acute form of catarrhal gingivitis, the patient will feel discomfort during hygiene procedures for cleaning the oral cavity and eating. The main symptoms of chronic catarrhal gingivitis are the following:

Pain syndrome.
Sensation of burning and itching when touched on the gums.
Thickening and thickening of the gingival margin.
Loose fit to the teeth of the papillae of the gums.
Change in color and size of gum papillae.
Blue gums filled with blood.
Bad breath.

Often, chronic catarrhal gingivitis is detected during a routine examination at the dentist or during the period when the disease begins to worsen.

Diagnosis of catarrhal gingivitis

Diagnosing catarrhal gingivitis is not difficult for a dentist or therapist. To establish the diagnosis, a patient is interviewed and an examination of the oral cavity is performed. In the process, the doctor can determine whether the infection is bacterial or viral. In order to identify the type of bacteria that provoked the occurrence of catarrhal gingivitis, a scraping is prescribed from the affected areas.

Apart from general diagnostics to determine the form of gingivitis, differential diagnostics is used to help distinguish between catarrhal, hypertrophic and chronic gingivitis, since they all have a similar clinical manifestation: bleeding gums, pain and redness of the gums.

Diagnosis using dental instruments involves probing the gum pockets. This allows you to determine the pathology of tooth mobility. In order to assess the integrity of the bone tissue of the fixed processes, an x-ray is prescribed.

Also, for accurate diagnosis, patients are shown general analysis blood and indexing of microbes and bleeding is carried out. These studies allow you to accurately prescribe treatment and determine the form of the course of the disease.

Treatment of catarrhal gingivitis

To eliminate catarrhal gingivitis, the doctor prescribes therapeutic treatment. It is aimed at getting rid of the harmful microflora of the oral cavity, which is the primary cause of the disease. In addition, it is necessary to eliminate general and local factors against which the pathogenic process may begin or continue.

You can achieve the desired results with the help of local treatment, which includes cleansing the oral cavity at a professional level. The complex of therapy also involves the treatment of an orthodontic plan, characterized by the replacement of previously installed fillings, the change and reinstallation of prostheses or implants. It is also important to completely cure caries.

Local treatment of catarrhal gingivitis consists in rinsing the oral cavity with antiseptic solutions, applications medicines on the affected areas of the gums, gum massage, the use of electrophoresis and paraffin therapy.

The general treatment of catarrhal gingivitis is carried out with the help of medications, which relieve inflammation, give an analgesic effect, and increase immunity. Often general treatment diseases include taking antibiotics.

Depending on the cause of catarrhal gingivitis, for example, allergies, viral diseases, various infections, and others, treatment is carried out in conjunction with other narrow specialists: endocrinologists, immunologists, gastroenterologists.

The prognosis for the treatment of catarrhal gingivitis will be favorable only if the patient notices discomfort in the oral cavity in a timely manner and consults a specialist in order to undergo a full examination by the dentist, and also undergoes the prescribed course of treatment. If the treatment of acute catarrhal gingivitis is not started in time, there is a high risk that the disease will become chronic form which is much more difficult to cure. In some cases, the disease can cause the development of ulcerative necrotic gingivitis and periodontitis.

Prevention of the disease lies in the correct, timely and regular oral hygiene. To do this, you need to consult a dentist who will tell you how and when to brush your teeth, as well as help you choose the right toothbrush and paste. It is important to pass preventive examination with a specialist twice a year.

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GBOUATOSARATOVGMUthem.V.I. RAZUMOVSKYMINISTRY OF HEALTHRUSSIA

CHAIRTHERAPEUTICDENTISTRY

STORYDISEASES

DIAGNOSIS chronic generalized catarrhal gingivitis, by 05.10

Curator: 4th year student

1 group of the Faculty of Dentistry

Student name

Mikailova Vezif Alishirinovna

Teacher

Arinina Ludmila Vladimirovna

SARATOV 2017

PASSPORTPART

Year of birth 1980 - gender male

Profession director

Diagnosis of chronic generalized catarrhal gingivitis, by 05.10

DATAINQUIRYSICK, COMPLAINTS

The patient complained of bleeding gums when brushing teeth, itching in the gums, an aesthetic defect in the form of plaque on the surface of all teeth.

ANAMNESISDISEASES

According to the patient, bleeding gums when brushing teeth arose more than 2 years ago. Itching in the gum area has been bothering me for about a year and a half. No previous treatment has been given.

ANAMNESISLIFE

gingivitis catarrhal disease chronic

INSPECTIONSICK

The face configuration has not changed. The opening of the mouth is free. Skin pale pink, moderately moist, without pathological formations. Visible mucous membranes and sclera of the eyes are clean.

Red border of lips without pathological changes, lips of a bright one-time color, moderately moisturized, without pathological changes.

On palpation regional The lymph nodes not palpable. Palpation of the masticatory muscles is painless. Palpation of the region of the temporomandibular joints is painless.

The mucous membrane of the lips is pink, clean, moist, veins are visible on the inner surface of the lips, there are nodular protrusions - small salivary glands, on the mucous membrane of the cheeks in the distal section along the line of closure of the teeth there are pale yellowish-gray tubercles with a diameter of 1-2 mm, not rising above the mucosa shell, at the level of the second upper molar there is a thickening of the mucous membrane - the papilla, at the top of which the mouth of the parotid duct opens salivary gland. Saliva during stimulation is released freely, transparent, without pathological inclusions.

The bite is orthognathic. The labial frenulum and lingual frenulum are of normal size. The vestibule of the oral cavity is of medium depth (5 mm). The bite is orthognathic.

The tongue is of normal size, pink in color, with a slight amount of plaque, moderately moist, without pathological changes. The state of the follicular apparatus of the tongue without pathological changes. The pharynx is pale pink, moderately moist, without pathological changes. The tonsils are without pathological changes.

The color of the teeth is yellowish, with a dry sheen. Teeth of the correct anatomical shape and size. In the cervical region of all teeth there is a soft plaque. Seals 1.6, 3.6, 3.7, 4.5, 4.6 are of satisfactory quality. KPU= 5. Anomalies in the position and shape of the teeth were not found.

Dental formula:

INSPECTIONFOCUSDEFEATS(STATUSLOCALIS)

Gingival papillae are swollen and hyperemic. When probing the gums, bleeding occurs. In the cervical region of the teeth of the upper and mandible there is soft dental plaque.

objectivesurvey

On palpation of the teeth, there is no pathological mobility.

AT PERCUSION (vertical and horizontal) there is no pain.

WHEN PROBING, bleeding of the gums is noted.

ADDITIONALMETHODSSURVEYS

HygienicindexGreen-Vermilion.

When staining the vestibular surface of the lower anterior teeth (16, 11, 26, 31), the lingual surface (36, 46) with Schiller-Pisarev solution, the presence of soft plaque is observed on the surface of all teeth of the upper and lower jaws in the cervical region, covering from 1/3 -2/3 of the tooth surface.

Evaluation criterion: 1*2+ 2*4=10;

Index value: 10/6=1, 7;

Index interpretation: 1, 7 - satisfactory level of hygiene

TrySchiller-Pisarev

Positive, staining of all gingival papillae brown.

PMA= 21% (mild gingivitis)

Rentgenography

On the orthopantomogram, there are no changes in the bone tissue of the jaws, the cortical plate is preserved throughout the alveolar process.

RATIONALEDIAGNOSIS

DIAGNOSIS Chronic generalized catarrhal gingivitis, by 05.10 was based on:

1) complaints: on the occurrence of bleeding gums when brushing your teeth, a feeling of itching in the gums, an aesthetic defect in the form of plaque on the surface of all teeth.

2)datahistorydiseases: according to the patient, bleeding gums during brushing teeth occurred more than 2 years ago. Itching in the gum area has been bothering me for about a year and a half. No previous treatment has been given.

3) life history data:

The nature of the diet - a full meal, 3 times a day. The patient notes that he eats a large amount of carbohydrates. Vitamins, biologically active substances does not use.

The nature of oral hygiene. He brushes his teeth once a day before meals, mainly with whitening pastes, he denies the use of floss. Bad habits- smoking.

Past diseases - chicken pox;

Concomitant diseases - absent;

The living conditions of the patient are satisfactory.

Allergy anamnesis is not burdened. Botkin's disease, sexually transmitted diseases, tuberculosis denies.

Heredity is not burdened.

THEORETICALPART

Gingivitis is an inflammation of the gums, caused by the action of general and local factors, and proceeding without violating the integrity of the gingival junction.

Forms: catarrhal, ulcerative, hypertrophic.

Weight: light, medium, heavy.

Course: acute, chronic.

Phases: exacerbation, remission.

Prevalence: localized, generalized.

Etiologycatarrhalgingivitis

Local factors contributing to retention and accumulation of plaque: poor oral hygiene,

malocclusion,

anomalies in the position of the teeth,

crowding of teeth;

lack of contact points between teeth (crowns, fillings, carious cavities of class II according to Black, tremas, diastemas);

overhanging edges of fillings of II and V classes, advancement of filling material under the gum, carious cavities of class V, wedge-shaped defects; irrational prosthetics (short or deeply advanced crowns under the gums; wide, uneven, jagged edge of the crown); pathology of the frenulum (high attachment of the frenulum of the lower lip, short frenulum); small vestibule of the oral cavity, strands of the vestibule;

consumption of sucrose

changes in the composition and properties of saliva (hyposalivation, xerostomia).

Pathogenesiscatarrhalgingivitis

The mechanism of pathological changes in the gums can be summarized as follows. The stage of early inflammation is characterized by penetration into the gum tissue a large number(up to 70% of the total number of cells) small and medium-sized lymphocytes, as well as polymorphonuclear leukocytes, macrophages, plasma and mast cells. Therefore, the morphological feature of the early stage of inflammation is precisely dense small cell infiltrates with a predominance of lymphocytes on preparations. Morphologically, the phase of established inflammation is characterized by the predominance of plasma cells in the cellular infiltrate, which reflect the immune response to damage. The main difference between the phase of progressive inflammation is that plasma cells make up to 80% of all exudate cells. This indicates chronic inflammation and active involvement of the immune mechanisms of inflammation. Plasma cells are the final stage in the development of B-lymphocytes, they provide humoral immunity through the active production of immunoglobulins. In the lesions of the periodontium, the number of plasma cells increases in proportion to the severity of the process and the degree of tissue destruction.

Clinicalpaintinganddiagnosticscatarrhalgingivitis

Characteristic signs of catarrhal gingivitis:

the disease is detected in children and adolescents or in young people;

the gum is hyperemic, edematous or in the area of all teeth, or several teeth;

periodontal connection saved;

depending on the intensity of inflammation, there is a different degree of bleeding, but a probe test for bleeding is always positive;

there is non-mineralized plaque and (or) tartar;

there are no signs of destruction of the interalveolar septa on the radiograph;

the general condition of patients is usually not disturbed, with the exception of acute and exacerbation of chronic catarrhal gingivitis.

Complaints of bleeding gums, the presence of dental deposits, a burning sensation in the gums.

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

differentialdiagnosticschroniccatarrhalgingivitisandchronicgeneralizedperiodontitislightdegree.

Common in the clinical picture of these diseases are

1) complaints of patients about bleeding gums, swelling and hyperemia of the gingival margin

2) the presence of soft and hard plaque

3) IG and PMA are more than normal, the Schiller-Pisarev test is positive.

Features:

1) with periodontitis, periodontal pockets up to 4 mm are determined

2) bone resorption of the interalveolar septum.

differentialdiagnosticschroniccatarrhalandhypertrophic(inedematousform)gingivitis

General: patients complain of bleeding gums, change appearance gingival margin. Usually, the proliferative process characteristic of hypertrophic gingivitis is preceded by catarrhal inflammation, therefore, catarrhal gingivitis can be observed on one jaw, and hypertrophic on the other.

Distinctive features are manifested in the specifics of general somatic diseases associated with various forms gingivitis. In catarrhal gingivitis, cardiovascular, gastrointestinal, infectious diseases, blood diseases (lympho- and myeloid leukemias). With hypertrophic gingivitis, there is often a hormonal imbalance, the influence of certain medications, and other blood diseases (leukemic reticulosis). There are also differences in the clinical picture: edema and hyperemia of the interdental papillae and the gingival margin in catarrhal gingivitis, enlargement of the gingival papillae, severe deformation of the gingival margin, sometimes a bluish tint, the formation of false gingival pockets in hypertrophic gingivitis.

TREATMENT

1 visit - 05.03.16

Education personal hygiene oral cavity.

Medical treatment of the oral cavity with 0.05% solution of chlorhexidine was carried out.

Rp.: Sol. Chlorhexidini bigluconatis 0.05% - 100ml

D.S. for medical treatment of the oral cavity.

Soft plaque was removed from all teeth of the upper and lower jaws using brushes and abrasive paste Detarthrin (Septodont). The rubber polishing head "Enhanse" polished all teeth, the proximal surfaces of all teeth were polished with strips, the cervical area was polished with brushes "OptyShine" (Kerr).

Treatment of the oral cavity with a 0.05% solution of chlorhexidine.

Coating the surface of the teeth with varnish "Belak-F".

Rp.: Belak-F - 25, 0

D.S. To cover the surface of the teeth after professional hygiene.

A periodontal bandage with butadione ointment was applied.

Rp.: Butadioni 5% - 20, 0

D.S. for applications on the gum area and periodontal dressings

Teaching standard brushing techniques.

Topically prescribed butadione ointment 2 r / d for applications for 7 days.

multivitamins "Kvadevit" 1 tab 3 r / d.

Rp.:Tab. «Qadevitum» No. 60

D.S. 1 tablet 3 times a day after meals

Carrying out finger automassage of the gums.

2 visit - 03.04.16

There are no complaints. The gums are pale pink in color, tightly cover the necks, teeth, moderately moistened. Gingival papillae are pale pink in color, of normal size and shape.

Determination of the level of oral hygiene IG = 1, 1 (satisfactory level). Controlled brushing of teeth.

Visiting the dentist every 3 months and following the rules of oral hygiene.

LITERATURE

one). "Practical Therapeutic Dentistry" Nikolaev A.I., Tsepov L.M. St. Petersburg Institute of Dentistry 2001.

2). "Propedeutics of dental diseases" Skorikova L.A., Volkov V.A., Bazhenova N.P., Lapina N.V., Erichev I.V. 2002

3). "Orofacial Pathology Selected Lectures" P.F. Averyanov, G.N. Maslyakov. Saratov. LLC Publishing Center "Nauka". 2011.

four). "Therapeutic dentistry" E.V. Borovsky, V.S. Ivanov, Yu.M. Maksimovsky, L.N. Maksimovskaya.

5). EM. Melnichenko. Prevention of dental diseases Minsk, 1990.

6). Prevention of dental diseases. Tutorial Moscow, 1997.

7). Kuzmina E.M. Prevention of dental diseases / E. M. Kuzmina.-M .: Uch. allowance, 2001. - 216 p.

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What are we dealing with?

Catarrhal gingivitis is one of the most common forms of gingivitis. Like many other diseases, it occurs in acute or chronic forms. The acute form usually affects children, adolescents, people under the age of 30-35 years. After this period, chronic gingivitis is more common.

If you think that the cause of the disease is exceptionally poor oral hygiene, then this is not so.

The etiology of catarrhal gingivitis is well understood. Sometimes this disease can be the result of other disorders in the body. Including diseases of the gastrointestinal tract, heart, disorders of the immune system, etc. Even some problems with hormones can lead to such manifestations.

But these reasons are general. Local ones are associated with tartar and abundant plaque, which was not removed in a timely manner. An incorrect bite, correction means that are not suitable for a particular patient () can also affect. Even a dentist who performs prosthetic procedures or installs dental fillings can be to blame.

There are also risk factors, including diabetes, smoking, transferred infectious diseases(flu, tonsillitis, tube infection), immunodeficiency states, including AIDS. Also, similar manifestations occur with heavy metal poisoning. It is also worth paying attention to the amount of vitamin C in the patient's diet. Some people react this way to the use of oral contraceptives. The body is unpredictable, you never know how it will behave in a given situation.

Forms and manifestations

The acute form appears suddenly for the patient and has pronounced symptoms, due to the presence of which he begins to take some action to eliminate the problem.

If a person stubbornly refuses to treat gingivitis, the disease becomes chronic and can manifest itself at any time.

Catarrhal gingivitis may have a small scale - a small area of \u200b\u200bthe gum is affected. Then it is called localized. If the inflammation covers the gum completely, this is already a generalized gingivitis of the catarrhal type.

There are only three levels of severity.

In the initial (light) periodontal papilla is affected. It increases in size, soreness, redness appears.
At medium degree severity of inflammation covers the free area of the gums.
In severe cases, the alveolar part.

Catarrhal gingivitis - manifestations in childhood

For parents, any problems in a child always seem more serious than they really are. Nevertheless, it is also not worth underestimating such a phenomenon as catarrhal gingivitis in children. First, gum disease is always dangerous. Secondly, the presence of such a process may indicate other problems in the body or the oral cavity in particular.

It is important to find the source of the problem. After all, inflammation is just the tip of the iceberg.

The disease affects children aged 2 years and older. In most cases, these children do not remove plaque well from the surface of the teeth, which provokes the growth of bacteria. Also, children put dirty hands in their mouths, which often leads to infections.

Catarrhal gingivitis in children

For the formation of inflammation of the gums, it is enough not to remove plaque from the teeth for 1.5-2 days. This leads to a proliferation anaerobic bacteria, which in turn give rise to inflammatory process. Also, problems cause malocclusion, crowding of teeth, adentia, caries, gum injuries. By the way, it is possible to injure soft tissues with improper cleaning or if the bristles are excessively stiff.

Another factor that should definitely be taken into account in the diagnosis is both dairy and first constants.

Often the cause is poorly processed edges of fillings. If they overlap the interdental spaces, interfering with normal oral hygiene, this can lead to inflammatory manifestations in the gum area between the filled teeth.

Also, with advanced stomatitis in a child, catarrhal gingivitis becomes a consequence of the fact that the parents of a young patient ignored the need for a timely visit to a doctor or at least the simplest procedures with soda, chlorhexidine and other available means.

If children eat hot or spicy foods, it can cause discomfort and even sore gums. They may itch and bleed visibly. There is usually bad breath. The patient does not feel the taste of food correctly.

Video - Forms of gingivitis in children

Preventive measures

What should be done or not done to avoid such problems? First of all, don't forget to brush your teeth. If you have a stone, see a specialist to have it removed. The sooner you do this, the better.

Methods of treatment in adults and children

Let's move on to the next question, when it's too late to drink Borjomi. That is, the patient did not carry out prophylaxis and it is necessary to deal with the existing causes and consequences.

In different people, the treatment of catarrhal gingivitis is far from the same. First, you need to individually determine the cause.

If there are caries, defects of the lips, frenulum of the tongue, bite, which lead to a problem, you need to eliminate them, so as not to bother with relapses later.

It is also worth checking whether everything is in order with the gastrointestinal tract, endocrine system, immunity. Might need complex treatment. Often, in addition to the dentist, you have to visit a gastroenterologist, ENT, allergist, etc.

Treatment of catarrhal gingivitis in children

During a visit to the dentist, he will remove plaque and tartar, check the teeth for carious lesions. The fewer such prerequisites for the development of infections in the mouth, the better. The next step is the use of antiseptics. It could be like pharmacy drug like chlorhexidine, and medicinal herbs(mint, chamomile, sage, eucalyptus). Gels are used (, Holisal, etc.).

Children may be prescribed UVI or electrophoresis.
Nutrition is also adjusted (minimum carbohydrates, more vegetables, fruits).
Take courses of vitamins.

A photo	Recommendations
	Prevent the transition of the disease to an acute stage. Treat chronic diseases
	Once every six months, remove plaque with professional cleaning oral cavity
	Support immune system organism by healthy lifestyle life. Take a vitamin complex
	In order not to injure the gums and not leave food residue in the mouth, you need to brush your teeth with a medium-hard brush.
	Properly use cleaning devices, such as thread or irrigators
	Constant visits to the dentist will lead to the timely detection of inflammatory processes and stop their development.
	Choose a paste on the advice of your dentist. He will be able to choose the right component for you in toothpaste: fluorine, calcium, etc.

In the fight against the manifestations of catarrhal gingivitis, therapy using drugs can be used. local action, including solutions of resorcinol or zinc chloride. Applications can also be applied to the affected areas. Aspirin, butadion and methyluracil ointments are effective for them. Chlorophyllipt, Romazulon and other means are also used.

Does it help? Very individual. It is enough for someone to remove plaque and stone, rinse their mouth for a couple of days and everything goes away. To get the same result, another needs to spend a lot of time and money on restoring immunity in the mouth, eliminating external manifestations, fighting infections, etc. Therefore, do not forget about preventive measures so that you do not suffer from long-term treatment later.

Video - Types and forms of gingivitis

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

Etiology of catarrhal gingivitis

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

Causal factors:

microbial;
mechanical, chemical, physical injury.

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

microbial plaque- this is a structural formation on the secondary cuticle of tooth enamel (pellicle), tightly connected to it. At first, more than 75% of it is aerobic microorganisms, or saprophytes: streptococci, staphylococci, actinomycetes, etc. Later, anaerobes (fusobacteria, treponemas, amoeba, trichomonads, etc.) begin to predominate.

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

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

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

The pathogenesis of catarrhal gingivitis

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

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

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

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

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

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

Clinical picture and diagnosis of catarrhal gingivitis

characteristic signs of catarrhal gingivitis:

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

It usually occurs in children due to a sharp increase in the pathogenic action of a microbial plaque, subject to a significant decrease in the activity of local and general protection factors, as a rule, due to a viral or other infection (ARVI, influenza, etc.), therefore it is rightly regarded as an almost natural complication of these and a number of other common diseases. The acute stage lasts from 3 to 7 days. In the case of recovery of the child, acute inflammation either disappears completely or becomes chronic. In adults, chronic catarrhal gingivitis as an independent form is rare.

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

Clinical and laboratory methods for diagnosing catarrhal gingivitis

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

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

At clinical analysis blood does not reveal specific changes characteristic of catarrhal gingivitis. Only the study of the capillary blood of the gums makes it possible to identify certain changes already in the initial stages of inflammation (an increase in the content of polymorphonuclear leukocytes, immunoglobulin, interleukins, complement protein fractions, etc.) compared with peripheral blood values. However, for practitioners, this is of no interest.

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

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

Treatment of catarrhal gingivitis

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

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

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

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

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

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

Treatment of catarrhal gingivitis in the acute stage It is aimed at eliminating the acute inflammatory reaction and associated pain and intoxication. Antibacterial, antiseptic, analgesic, anti-inflammatory (ketorolac n ar.), sometimes hyposensitizing (clemastine (tavegil), chloropyramine (suprastin), mebhydrolin (diazolium), etc.) agents are prescribed. The patient is not recommended to eat spicy, irritating food during this period.

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

These interventions are carried out not only to eliminate the acute inflammatory reaction, but also in the treatment of chronic catarrhal gingivitis. However, in the exacerbation phase, it is absolutely impossible to carry out traumatic manipulations, and brushing your teeth should be replaced with antiseptic rinses. Only after the elimination of the phenomena of acute inflammation, it is possible to proceed to the full-fledged professional hygienic treatment and the entire necessary complex of treatment.

Catarrhal gingivitis - diagnosis and treatment in adults and children. Exacerbation of chronic catarrhal gingivitis - symptoms and methods of treatment Catarrhal gingivitis etiology pathogenesis clinic diagnostics

The reasons

Symptoms

Classification

Diagnostics

Treatment tactics

In adults

In children

Fighting exacerbations

Prevention

Causes of catarrhal gingivitis

Classification of catarrhal gingivitis

Symptoms of catarrhal gingivitis

Diagnosis of catarrhal gingivitis

Treatment of catarrhal gingivitis

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Etiology of catarrhal gingivitis

The pathogenesis of catarrhal gingivitis

Clinical picture and diagnosis of catarrhal gingivitis

Clinical and laboratory methods for diagnosing catarrhal gingivitis

Treatment of catarrhal gingivitis