In the article we will consider the treatment of hypertrophic gingivitis.
This is an inflammatory change in the tissues of the gums, which is accompanied by their growth with the formation of periodontal pockets that overlap the dental crown. Clinical symptoms of gingivitis are represented by swelling, hyperemia, burning and bleeding of the gums (when brushing, touching, while eating), pain in the form of a reaction to cold, hot or sour food, unaesthetic appearance of the gums. Diagnosis of this disease includes palpation and examination, determination of dental indices, and X-ray examination. In the treatment of gingivitis, local anti-inflammatory procedures, sclerotherapy, gingivectomy, diathermocoagulation of the gingival papillae are used.
Description of pathology
Hyperplastic (hypertrophic) gingivitis is a type of chronicgingivitis, which occurs with a predominance of the proliferative process in the gum tissues. In dentistry, this pathological process is diagnosed in 3-6% of persons suffering from periodontal diseases. The onset of hypertrophic gingivitis is usually preceded by prolonged catarrhal inflammation of the gums (catarrhal gingivitis).
This form of gingivitis can be an independent pathology or accompany symptoms of generalized periodontitis. In this disease, despite a significant increase in the volume of gum tissues, the integrity of the dentoepithelial attachment is not disturbed, and changes in the bone tissue of the alveoli are also not observed. Before considering the treatment of hypertrophic gingivitis, let's talk about the causes of the pathology.
Reasons
General and local factors may be involved in the development of this pathological process.
If we talk about the local causes of hypertrophic gingivitis of the gums, of particular importance belongs to:
- Changes in bite (open or deep bite).
- Tooth anomalies (crowding, twisting, supernumerary teeth).
- Deposits (plaque and calculus).
- Mechanical trauma to the gums.
- Low bridle attachment.
- Incorrectly placed fillings or fitting dentures.
- Inadequate oral hygiene when using any orthodontic appliances, etc.
The etiology of hypertrophic gingivitis is of interest to many.
Influence of hormonalbackground
Among the common causes contributing to the onset of the disease, the main role belongs to hormonal status disorders, so the pathology often develops during puberty, menopause, pregnancy. Gingivitis of pregnant women and youthful gingivitis are often singled out as independent forms of the disease in periodontology. Other causes of hypertrophic gingivitis can be endocrine pathologies (diabetes mellitus, thyroid disease), medication (antiepileptic drugs, calcium channel blockers, oral contraceptives, immunosuppressive agents, etc.), leukemia, hypovitaminosis.
We continue to consider the causes and symptoms of hypertrophic gingivitis.
Disease classification
According to the prevalence of the pathological phenomenon, localized (in the region of 1-4 teeth) and generalized gingivitis differ. Often, localized superficial types of this disease are combined into a separate pathology - papillitis.
Depending on the type of hyperplastic processes, gingivitis can occur in a fibrous (granulating) form, and in an edematous (inflammatory) form. Morphological changes in edematous forms of the pathological process include edema of the connective tissue of the fibers of the papillae of the gums, lymphoplasmacytic infiltration, and vasodilation. In the fibrous form of this disease, a proliferation of papillary fibers, an increase in collagen fibers, parakeratosis with minimal pronounced swelling and inflammatory infiltration are detected under a microscope.
Stages
In accordance with the growth of gum tissue, there are three stages of acute catarrhal gingivitis. Symptoms and treatment are discussed below.
- Easy stage - hypertrophy of the papillae of the gums at the base, when the overgrown gingival margin covers the dental crown by 1/3.
- Medium - progression of growth and dome-shaped change in the shape of the papillae of the gums, in which the overgrown gum covers the dental crowns by about half.
- Severe - pronounced growth of the gingival papillae and gingival margins when they cover more than half of the dental crowns.
Symptoms of disease
With edematous forms of gingivitis, patients experience burning, soreness and bleeding of the gums when eating, hypertrophy of the papillae, bright red color of the gums. During a dental examination, swelling and enlargement of the gingival papillae, gingival hyperemia with a bluish tinge, bleeding during probing, and the presence of dental deposits are noted. Typically, the formation of false periodontal pockets, which contain detritus. The integrity of the dentogingival connection in this pathological process is not broken.
With fibrous gingivitis, complaints about the massiveness of the gums come to the fore, to the touch - their density, unaesthetic appearance. An overgrown gum often prevents the patient from chewing food. The gums have a pale pinkish color, they are painless, with an uneven, bumpy surface, and do not bleed when touched. Examination may reveal the presence of hard and soft subgingival deposits.
It is especially important to timely treat hypertrophic gingivitis in children.
Gingivitis in children
Hypertrophic gingivitis in children is a periodontal pathology characterized by inflammation of the marginal parts of the gums directly adjacent to the necks of the teeth and interdental papillae. In pediatric dentistry, gingivitis is a common disease, occurring in 3% of children aged 2-5 years. Among older children, this figure is significantly higher. According to epidemiological tests, the most common chronic type of catarrhal gingivitis, which is provoked by the presence of plaque containing pathogenic bacteria on the teeth.
Childhood is the time of active biological processes in periodontal tissue: morphological changes in gum tissue, teething, root formation and bite formation. During puberty, periodontal tissue actively responds to hormonal changes, which contributes to the creation of a morphofunctional basis for the formation of inflammation.
Diagnosis of hypertrophic gingivitis
The main plan for examining a patient with hypertrophic gingivitis includes the establishment of a periodontal index, hygiene index, papillary-marginal-alveolar index (PMA), Schiller-Pisarev test, and, if necessary, morphological studies of gum tissue and biopsy. When performing an x-ray (intraoral or panoramic x-ray, orthopantomography), as a rule, no changes are observed or (with prolongedduring hypertrophic gingivitis) osteoporosis of the apex of the interdental septum is determined.
Differential Diagnosis
In differential diagnosis, it becomes necessary to exclude gum fibromatosis, epulis, gum growth in periodontitis. Patients with hypertrophic gingivitis, as well as some concomitant pathologies, should be consulted by doctors of the appropriate profile: gynecologist, hematologist, endocrinologist, etc.
Treatment of hypertrophic gingivitis
Patients with this pathological phenomenon require the help of a dentist, hygienist, orthopedist and periodontist. Therapy of edematous forms of gingivitis includes the elimination of dental deposits, treatment of the oral mucosa with antiseptics, oral baths and rinses with herbal decoctions, periodontal applications, gum massage, physiotherapy (electrophoresis, galvanization, ultrasound, darsonvalization, laser therapy).
With the ineffectiveness of local anti-inflammatory procedures in the treatment of hypertrophic gingivitis of the edematous form, the patient may be prescribed sclerosing therapy - injection into the papillae of a solution of gluconate or calcium chloride, ethyl alcohol or glucose. This is usually done under local anesthesia.
In order to reduce swelling and severity of the inflammatory process in hypertrophic gingivitis, certain hormonal ointments are rubbed into the papillae of the gums, or steroid hormones are injected. During treatmentfibrous form of hypertrophic gingivitis, conservative methods are most often used. At the same time, diathermocoagulation of hypertrophied papillae or cryodestruction and gingivectomy comes to the fore - an operative method in which the overgrown gums are excised.
Local treatment of hypertrophic gingivitis should include the elimination of the traumatic causes of its development: restoration of teeth, replacement of fillings, elimination of defective prostheses, grinding of the occlusal surface, orthodontic therapy, plastic surgery of the frenulum of the tongue and lips, etc. The criteria for the cure of this disease are the disappearance of external gingival disorders and subjective discomfort, the normalization of the dental index, the absence of periodontal pockets.
Folk treatments
Most folk recipes for the treatment of gingivitis are highly effective, they are easy to use and prepare and do not require large expenses. Nevertheless, such procedures should be carried out under the supervision and with the permission of a doctor.
Medicinal herbs have strong anti-inflammatory properties and speed up the healing process. The most famous of them are chamomile, yarrow, calendula, sage, oak bark, aloe, celandine. With hypertrophic gingivitis, you can use the following recipes based on these herbs:
- 1 tablespoon of dry flowers of chamomile, yarrow and calendula is poured into 300 ml of hot water and infused for an hour in a thermos. Sodecoction should rinse your mouth 3 times a day.
- Sage has a pronounced antimicrobial effect, relieves pain and inflammation. Boil 2 tablespoons of a dry plant in 200 ml of water and cool. Mouth rinses are carried out with warm infusion 2 times a day.
- Oak bark and celandine have an astringent effect. They reduce bleeding and swelling of the gums with gingivitis. In equal proportions, you need to mix oak bark and celandine grass, insist 4 tablespoons of this mixture in two glasses of water in a thermos and rinse your mouth every 5 hours.
Prevention of gingivitis
With hypertrophic juvenile gingivitis and this pathology in pregnant women, it makes sense to use exclusively conservative treatment, since after stabilization of the hormonal balance and childbirth, gingival hyperplasia decreases or disappears completely. This pathological phenomenon is prone to recurrence, so it is extremely important to eliminate all provoking local and general factors.
Prevention of gingivitis comes down to the exclusion of mechanical injury to the gums, regular oral hygiene in clinics, proper care of teeth and gums, and the exclusion of dental problems of the patient. It is also necessary to treat endocrine pathologies, rational selection of medications.
We reviewed the causes and classification of hypertrophic gingivitis.
