The article will consider the treatment of hypertrophic gingivitis.
This is an inflammatory change in the gum tissue, which is accompanied by their growth with the formation of periodontal pockets that overlap the tooth crown. The clinical symptoms of gingivitis are represented by swelling, hyperemia, burning and bleeding of the gums (when cleaning, touching, eating), pain in the form of a reaction to cold, hot or acidic foods, and an 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.
Pathology Description
Hyperplastic (hypertrophic) gingivitis is a type of chronic gingivitis that occurs with a predominance of the proliferative process in the gum tissue. In dentistry, this pathological process is diagnosed in 3-6% of people suffering from periodontal diseases. The occurrence of hypertrophic gingivitis is usually preceded by prolonged catarrh of the gums (catarrhal gingivitis).
This form of gingivitis may be an independent pathology or may accompany symptoms of generalized periodontitis. In this disease, despite a significant increase in the volume of gum tissue, the integrity of the dentoepithelial attachment is not violated, 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 pathology.
Causes
In the development of this pathological process, general and local factors can participate.
If we talk about the local causes of gingival hypertrophic gingivitis, of particular importance:
- Bite changes (open or deep bite).
- Tooth abnormalities (crowding, twisting, supernumerary teeth).
- Dental deposits (plaque and stone).
- Mechanical gum injuries.
- Low fastening bridle.
- Incorrectly placed fillings or selected dentures.
- Inadequate oral hygiene when using any orthodontic appliances, etc.
The etiology of hypertrophic gingivitis is of interest to many.
Hormonal effects
Among the common causes contributing to the onset of the ailment, the main role belongs to hormonal status disorders, so pathology often develops during puberty, menopause, and pregnancy. Often, pregnant women gingivitis and juvenile gingivitis are distinguished as independent forms of the disease in periodontology. Other causes of hypertrophic gingivitis can be endocrine pathologies (diabetes mellitus, thyroid disease), taking medications (antiepileptic drugs, calcium channel blockers, oral contraceptives, immunosuppressive drugs, etc.), leukemia, hypovitaminosis.
We continue to consider the causes and symptoms of hypertrophic gingivitis.
Disease classification
The prevalence of the pathological phenomenon distinguishes between localized (in the region of 1-4 teeth) and generalized gingivitis. Often, localized superficial types of this disease are combined into a separate pathology - papillitis.
Depending on the variety of hyperplastic processes, gingivitis can occur in fibrous (granulating) form, and in edematous (inflammatory). Morphological changes in edematous forms of the pathological process include swelling of the connective tissue of the fibers of the papilla of the gums, lymphoplasmocytic infiltration, and vasodilation. With the fibrous form of this disease under the microscope, proliferation of papilla fibers, an increase in collagen fibers, parakeratosis with minimal severe swelling and inflammatory infiltration are detected.
Stages
In accordance with the proliferation of gum tissue, three stages of acute catarrhal gingivitis are distinguished. Symptoms and treatment are discussed below.
- The easy stage is hypertrophy of the gum papillae at the base, when the overgrown gingival margin closes the tooth crown by 1/3.
- Medium is the progression of proliferation and a dome-shaped change in the shape of the papilla of the gums, in which the overgrown gum covers the tooth crowns by about half.
- Severe - pronounced growth of the gingival papillae and the edges of the gums, when they cover the tooth crowns by more than half the height.
Symptoms of the disease
With edematous forms of gingivitis, patients experience burning, soreness and bleeding of the gums when eating, hypertrophy of the papillae, and a bright red color of the gums. During a dental examination, there is swelling and an increase in the gingival papillae, gingival hyperemia with a bluish tinge, bleeding during probing, and the presence of dental plaque. Typically, the formation of false periodontal pockets containing detritus. The integrity of the gingival connection with 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. Overgrown gums often prevent the patient from chewing food. Gums have a pale pinkish color, they are painless, with an uneven, tuberous surface, do not bleed during touch. Inspection may reveal the presence of hard and soft subgingival deposits.
It is especially important to conduct timely treatment of 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 that occurs in 3% of children aged 2-5 years. Among older children, this indicator is significantly higher. According to epidemiological tests, the most common catarrhal gingivitis of the chronic type, which is provoked by the presence on the teeth of plaque containing pathogenic bacteria.
Children's age is the time of active biological processes in periodontal tissue: morphological changes in gum tissue, teething, root formation and bite formation. In the puberty, periodontal tissue actively responds to hormonal changes, which helps to create a morphofunctional basis for the formation of inflammation.
Diagnosis of hypertrophic gingivitis
The main plan for examining a patient with hypertrophic gingivitis includes establishing a periodontal index, hygiene index, papillary-marginal-alveolar index (RMA), Schiller-Pisarev test, and, if necessary, morphological studies of gum tissue and biopsy. When conducting an x-ray (intraoral or panoramic image, orthopantomography), as a rule, no changes are observed or (with a prolonged course of hypertrophic gingivitis) osteoporosis of the apex of the interdental septum is determined.
Differential diagnosis
With differential diagnosis, it becomes necessary to exclude gum fibromatosis, epulis, gum proliferation with periodontitis. Patients with hypertrophic gingivitis, as well as some concomitant pathologies, should be consulted by doctors of the appropriate profile: gynecologist, hematologist, endocrinologist, etc.
Hypertrophic gingivitis treatment
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).
If local anti-inflammatory procedures are ineffective in the treatment of edematous hypertrophic gingivitis, the patient may be prescribed sclerotherapy - injection of gluconate or calcium chloride, ethyl alcohol or glucose into the papillae. This is usually done under local anesthesia.
In order to reduce the swelling and severity of the inflammatory process with hypertrophic gingivitis, certain hormonal ointments are rubbed into the gum papillae, or steroid hormones are injected. In the treatment of the fibrous form of hypertrophic gingivitis, conservative methods are most often used. At the same time, diathermocoagulation of hypertrophied papillae or cryodestruction and gingivectomy come to the fore - an operational method in which excised areas of the gum 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 tongue and lip frenum, etc. Criteria for the cure of this disease are the disappearance of external gum disorders and subjective discomfort, normalization of the dental index, and the absence of gingival pockets.
Alternative methods of treatment
Most of the 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 the doctor.
Medicinal herbs have strong anti-inflammatory properties and accelerate 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 dried chamomile, yarrow and calendula flowers is poured into 300 ml of hot water and infused for an hour in a thermos. Such a decoction should rinse your mouth 3 times a day.
- Sage has a pronounced antimicrobial effect, relieves soreness and inflammation. 2 tablespoons of a dry plant need to be boiled in 200 ml of water and cool. Warm infusion rinses the mouth 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.
Gingivitis Prevention
With hypertrophic juvenile gingivitis and this pathology in pregnant women, it makes sense to use exclusively conservative treatment, since after stabilizing the hormonal balance and childbirth, gingival hyperplasia decreases or disappears completely. This pathological phenomenon is prone to recurrence, therefore it is extremely important to eliminate all provoking local and general factors.
Prevention of gingivitis is reduced to the exclusion of mechanical injury to the gums, regular oral hygiene in clinics, proper care for teeth and gums, and the exclusion of the patient’s dental problems. Also necessary is the therapy of endocrine pathologies, a rational selection of medications.
We examined the causes and classification of hypertrophic gingivitis.