Gum disease: what is gingivitis?
Gingivitis is an inflammatory process of the gingival mucosa. It is characterized by swelling and redness of the gums, bleeding during eating and minimal contact, an unpleasant odor from the mouth, and sometimes – the appearance of erosion. With the hygiene of the oral cavity and timely treatment, a complete cure comes. There may be a chronic, relapsing course leading to the development of periodontitis with subsequent exposure of the necks of the teeth, their loosening and loss.
Causes of gingivitis
The main cause of gingivitis is sticky plaque. It accumulates along the edges of the gums and in hard-to-reach areas for cleansing teeth, after 72 hours the plaque is compacted and tartar is formed, which can not be removed with the usual brushing of teeth.
In the pubertal period and during menstruation, the likelihood of gingivitis increases. Women who take oral contraceptives for a long time are also at risk.
Reception of immunosuppressors, in particular – cyclosporine, and antihypertensive drugs containing nifedipine, as a side effect provoke the development of hypertrophic gingivitis. These drugs cause gingival tissue hyperplasia, which makes it difficult to care for your teeth and daily plaque removal.
Accumulation of plaque and reproduction of microorganisms contribute to the development of gingivitis.
Endogenous causes of gingivitis is the growth of teeth. As the growing tooth injures the gum, children are often diagnosed with catarrhal gingivitis during teething. Lack of vitamin C, diseases of the gastrointestinal tract, reduction of general and local immunity occupy a significant role in the pathogenesis of gingivitis. Thus, in people without pathologies, the short-term inability to observe oral hygiene does not lead to the development of gingivitis.
The effects of external physical factors such as trauma, burns, radiation exposure and the influence of aggressive chemicals on the gum are the most common causes of gingivitis. Bacterial agents cause gingivitis in most cases in children and adults with impaired immune system.
Recently, an important role in the occurrence of gingivitis is played by iatrogenic factors, when patients with weak psyche, under the pressure of information flow about the importance of oral care, detect symptoms of gingivitis. Incorrect behavior of the doctor, can also provoke the appearance of gingivitis of a psychogenic nature. Gingivitis is more susceptible to smokers, patients with tartar and people who drink excessively hot or cold food.
In children before puberty, immune defense is only formed, so the presence of foci of chronic infection, tooth decay leads to the development of gingivitis. The percentage of incidence of gingivitis in children with tuberculosis infection, rheumatism, liver and gallbladder disease is higher. At a diabetes mellitus the chemical composition of a saliva changes, its antibacterial properties decrease. Among those suffering from any form of diabetes, gingivitis occurs in 70% of cases.
Gingivitis rarely develops as an independent disease. Much more often it is a symptom of other diseases of the oral cavity or a consequence of diseases of the internal organs.
With gingivitis, the integrity of the tooth-gum joint is not impaired, but due to puffiness of the interdental papillae, an increase in their volume creates an apparent deepening of the gingival groove.
With a localized process, gum disease is determined in the region of the group of teeth. For the generalized process is characteristic; the spread of inflammation on the mucosa of the alveolar process in the region of all the teeth of the upper jaw and the alveolar part of all the teeth of the lower jaw.
In other cases, the disease is limited to one jaw (more often – the lower one), and the inflammation of the gum proceeds with the predominance of the exudative component.
Signs of gingivitis
Gingivitis symptoms are not always clearly visible. Besides swollen gums, there are other symptoms, that doctor can determine. For gingivitis, regardless of the clinical and morphological form, the following differential diagnostic signs:
- the disease is detected mainly in children and young people;
- presence of non-mineralized nasal deposits (microbial deposit, soft deposits, food residues) and supragingival tartar;
- a direct correlation between the indices of the hygienic index and the severity of gingivitis;
- a common combination of gingivitis with focal demineralization (caries in the stain in the cervical region);
- the presence of certain clinical and morphological manifestations of inflammation in the gum and its deformation;
- bleeding when probing in the gum, no gingival pocket;
- absence of destruction of interdental septa;
- the general condition of patients is not disturbed, with the exception of acute or exacerbated chronic catarrhal and ulcerative gingivitis, in which an intoxication of the organism is observed depending on the degree of severity and prevalence of the disease.
Patients complain of unpleasant sensations in the gums, itching sensation, smell from the mouth, taste distortion, bleeding gums during eating or brushing teeth, can be staining oral fluid in pink. In acute course or exacerbation of the chronic course, pain is intensified during food intake as a result of the influence of mechanical and chemical stimuli.
The general condition of the patients suffers a little, however the periods of an exacerbation can be accompanied by a malaise, subfebrile temperature.
Acute catarrhal gingivitis is characteristic for the period of eruption and change of teeth. It is observed in acute infectious and other common diseases.
Chronic catarrhal gingivitis is characterized by a prolonged sluggish course; complaints are poorly expressed. Inflammatory process can be limited to the interdental papillae and marginal gum or extends to the entire alveolar part of the gum, there may be limited – localized or generalized – spilled.
In an objective examination, edema, hyperemia, cyanosis of the gum, its thickening, limited foci of desquamation, single erosions, mainly in the region of the tips of the interdental papillae, are noted; mechanical irritation is accompanied by bleeding. Due to the swelling of the gum, it is sometimes possible to assume the presence of periodontal pockets, but there are none, since the integrity of the dentogingival joint remains intact.
On the teeth – high content of soft plaque (patients avoid brushing their teeth due to soreness and bleeding gums), sometimes the plaque is stained with pigments of blood or coloring substances of food. Often there is a solid colored (green) plaque on the teeth in the cervical region.
The general condition of patients, as a rule, is not violated, changes in peripheral blood are not detected. On the roentgenogram, bone tissue is unchanged.
This is a chronic inflammatory process of the gum accompanied by proliferative phenomena. Chronic hypertrophic gingivitis in children is usually a generalized process, although at first glance it seems that the process involves periodontal disease in a restricted area.
Most often, gingival hypertrophy seizes the frontal areas of the upper and lower jaws, areas with tight teeth and abnormal attachment of soft tissues, as well as jaw fragments corresponding to an abnormal relationship giving an overload, underload or mechanical gum trauma. Depending on the nature of tissue proliferation, hypertrophic gingivitis is clinically divided into fibrous (granulating) and edematous (inflammatory) forms.
By prevalence, generalized and localized hypertrophic gingivitis is distinguished.
With mild degree of gingival hypertrophy reaches no more than 1/3 of the crown of the tooth, at an average severity – no more than 1/2, in case of severe – the enlarged gum covers 2/3 or the entire crown of the tooth.
Localized process develops with anomaly of the location of the teeth, their crowding, trauma of the mucous membrane with overhanging fillings, artificial crowns, clasps and is diagnosed with hypertrophic papillitis.
The generalized process is observed mainly with endocrine diseases, adolescents in the pubertal period, during the intake of diphenin preparations, in hypovitaminosis C, blood diseases, etc. This should be noted, since hypertrophic gingivitis in these cases may be the only early symptom of the underlying disease.
The most frequent localization of hypertrophic gingivitis is the gingival margin of the vestibular surface of the anterior teeth. The proliferation of the gingival papilla is often combined with abnormal position of the teeth or malocclusion, which leads to gum injuries. The gingival papillae are edematous, friable, cyanotic, enlarged in size, with sharply pronounced uneven fecundity of the margin. The enlarged gingival papilla can completely cover the crowns of the teeth and be injured during chewing.
The nature of complaints is determined by the severity of the disease:
With edematic (granulating) form, patients complain of gum proliferation, itching, bleeding and pain, which is aggravated during food intake and significantly disturbs the act of chewing, an unpleasant odor from the mouth.
Due to the significant growth of the gums, false gingival pockets are determined, often exudate is released from them, but the gingival joint is not disturbed.
In the cervical area of the teeth, in the areas of gingival hypertrophy a large amount of soft or pigmented plaque is found, firmly associated with the hard tissues of the tooth.
The vertices of the hypertrophied gingival papillae are sometimes necrotic. Additional methods of investigation allow to reveal the inflammatory process of the mucous membrane of different intensity.
Fibrous form of hypertrophic gingivitis proceeds benignly. Patients do not complain (with mild degree) or complain about unusual appearance and shape of the gum (with moderate to severe severity).
With mild hypertrophic gingivitis, the gingival papillae are normal color or paler than healthy areas of the gum, tightly adjacent to the tooth, although deformed and enlarged in size, do not bleed, since false pockets are shallow, there are no excretions of them. For medium and severe degree (especially if the process is generalized), there are significant gum proliferation, equally pronounced both from the vestibular and lingual surfaces of the teeth.
Acute ulcerative gingivitis develops in children as a consequence of acute catarrhal. For this form of the inflammatory process of the gum is characterized by necrosis and ulceration that develop with a decrease in the reactivity of the organism as a hyperergic reaction to sensitization of tissues with fusospirillar symbiosis. The presence of ulcerative gingivitis indicates a serious disturbance of the organism’s reactivity due to common diseases or a decrease in gum tissue resistance.
The development of ulcerative gingivitis is sometimes preceded by the transferred infectious disease (influenza, acute herpetic stomatitis, etc.), hypothermia, teething, and others.
Ulcerative gingivitis is always preceded by a stage of catarrhal inflammation, therefore the first clinical signs of the disease are gum pain and itching, then their hyperemia, edema, stagnant phenomena in which the gingival margin is cyanotic, easily and profusely bleeds with minor mechanical trauma.
The first signs of ulceration are located along the gingival margin, with a particularly aggressive process necrotizing the gingival papillae and marginal gingiva. These areas are covered with a gray or dirty-green coating, the teeth are plentiful, soft, with difficulty removing the plaque. The tongue is imposed.
Saliva is viscous, viscid. The unmodified mucous membrane of the oral cavity is covered with an easily removable fibrinous coating, and a putrid smell from the mouth. The course of ulcerative-necrotic gingivitis is long. The disease is accompanied by intoxication, food chewing is broken, the child is depleted, poorly awake, and capricious.
Ulcerative gingivitis in children
Ulcerative gingivitis in a child under 3 years old in the absence of an acute infectious disease makes you think about the Letterter-Sive syndrome, blood diseases, in a child of preschool and primary school age – about blood diseases and reticulogistiocytosis of the type of Hyunda-Schuller-Crischen disease.
In children of middle and senior school age, gingivitis can have an independent character in the form of Vincent’s gingivitis caused by fusospirillar symbiosis, provided that the reactivity of the organism decreases and the hygienic content of the oral cavity is poor.
Ulcerative gingivitis, limited by the area of the frontal teeth of the lower or upper jaw, can develop in the presence of traumatic occlusion due to the abnormal position of the teeth and the ratio of the jaws.
Atrophic (Desquamitive) gingivitis
Atrophic gingivitis can develop due to underdosed orthodontic treatment and insufficiency of the alveolar base. Often atrophy of the gingival margin develops under the influence of abnormal attachment of bridles (often the lower, rarely the upper lip) or powerful cords of the mouth (powerful gingival ligaments). In these cases, tissue atrophy is localized in the region of individual teeth: the inferior frontal, canines or premolars.
A special form is V-shaped atrophic gingivitis, characterized by progressive atrophy of the gingival margin with minimal signs of inflammation. At first, the marginal gingiva is atrophied, then the bone of the socket. The naked neck of the tooth and cement retain their natural color and look smooth, as if polished.
Atrophy of tissues in the region of the gingival margin from the side of the palate is less pronounced, in connection with which the periodontium from the palatine surface remains normal form and shape. The gum edge during a certain stabilization of the process becomes denser, and along its margin appears a pronounced cushion of hypertrophied tissue. The color of the gum changes little.
In most cases, this kind of dystrophic changes in the periodontal tissues do not cause painful and unpleasant sensations to the child. Sometimes there can be pain from temperature irritants.
Diagnosis and treatment of gingivitis
Your doctor can diagnose gingivitis during visual and instrumental examinations. An additional diagnosis is not required. However, in order to identify the root cause, a thorough questioning of the patient and examination by another periodontist is necessary. Before detection and correction of the disease, which is the cause of gingivitis, resort to local treatment.
When gingivitis is necessary to clean teeth from plaque and tartar and recommend patients to carefully observe the oral hygiene. Persons who are predisposed to the occurrence of gingivitis, you need to visit the dentist more often for professional hygiene of the oral cavity.
It shows the use of drugs that improve local immunity. After eating, always rinse the mouth with antiseptic solutions and herbal decoctions. Rinsing with non-aggressive compounds, for example decoction of chamomile, can be carried out without restrictions, but it should be borne in mind that with gingivitis with caution, you need to use solutions of soda and alcohol solutions of medicinal herbs. If gingivitis has a pronounced pain syndrome, then analgesics are justified.
Hypertrophic gingivitis often occurs due to improper filling and insertion of the crowns. Replacement of restorations leads to complete cure. Gingivitis, which arose on the background of pregnancy, taking medications, is self-inflicted after childbirth or withdrawal of medicines. If the tissue hyperplasia is of a persistent nature, then gingivectomy is shown with the removal of growths.
The prognosis for gingivitis is favorable, but in the absence of treatment the process can go into a deep form – develop periodontal disease, in which tooth loss can occur.