Gingivitis - causes, types of gingivitis, its complications and treatment

From this article you will learn:

• what causes gingivitis,
• what are the forms of this disease,
• gingivitis in adults - symptoms and treatment at the dentist.

The article was written by a dentist with more than 19 years of experience.

Gingivitis is an inflammation of the marginal part of the gum adjacent to the teeth, including the interdental papillae (Fig. 1-2). With this disease, patients most often complain of bleeding gums, pain when brushing teeth, as well as swelling, redness or cyanosis of the gums. Gingivitis with a predominance of such symptoms is usually called “catarrhal” by dentists.

However, in a small percentage of cases, inflammation can also manifest as gingival overgrowth, or even ulceration and necrosis. The most important feature that distinguishes gingivitis from other inflammatory gum diseases is that the inflammation does not spread deeper than the gum mucosa. Accordingly, with gingivitis there is no destruction of the bone tissue around the teeth, no mobility of the teeth, i.e. symptoms of a disease such as periodontitis.

Gingivitis: photo, diagram

If you have mobility of some teeth, as well as periodontal pockets, from which pus can be released during periods of exacerbation, such symptoms no longer indicate gingivitis, but the presence of periodontitis (a more severe form of gum inflammation). You can read more about this disease at the link above. Let us only note that in most cases the development of periodontitis is a consequence of untimely and/or ineffective treatment of gingivitis.

Main forms of gingivitis:

• catarrhal gingivitis (Fig. 1-8),
• ulcerative-necrotizing gingivitis (Fig. 12-15),
• hypertrophic gingivitis (Fig. 16-18).

In this article we will analyze in detail each form of gingivitis, indicating effective drugs and regimens for their use. We will also list patients’ mistakes in the process of self-medication, which often lead to the development of severe chronic gum inflammation. If you are more interested in how to properly treat gingivitis not in adults, but in children, then read more about this in the article: → Gingivitis - symptoms and treatment in children

Causes of gingivitis

The most common cause of gingivitis is poor personal oral hygiene. Violation of the rules may consist of inappropriate technique, irregular brushing of teeth, refusal to use dental floss and rinses after meals. As a result, food particles accumulate between the teeth, and a large amount of soft plaque forms on the surface of the teeth. This is a favorable environment for the proliferation of bacteria, which leads to the inflammatory process.

Soft plaque, which is not removed for a long time, mineralizes and hardens over time. When tartar appears, pathogenic microorganisms also actively multiply on it. In addition, the sharp edges of hard deposits injure the gum margin, which reduces local protective factors.

There are other common local causes of gingivitis:

• unsound orthopedic, orthodontic structures: braces with sharp edges,
• chips of enamel, destruction of teeth and fillings: injury to mucous membranes with sharp edges;
• teething disorders, dental caries, pulpitis, periodontitis, abscesses and other diseases;

Systemic pathologies and certain conditions can lead to the development of gum inflammation. The most common ones are:

• endocrine diseases - diabetes mellitus, Graves' disease, etc.;
• diseases of the digestive system - gastroesophageal reflux, Crohn's disease, chronic cholecystitis, etc.;
• hypovitaminosis, lack of minerals due to a strict diet or impaired absorption of nutrients;
• taking certain medications - antidepressants, local vasoconstrictors, antibiotics, combined contraceptives, beta-blockers, etc.;
• past infections and surgical interventions;
• puberty, pregnancy, menopause - changes in hormonal status not associated with illness;
• allergic reactions to food, medicines, hygiene products;
• bad habits.

Often there is a combination of factors - a combination of local and general causes of weakening of immune forces. You can find out the exact reasons only with the help of a doctor.

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Diagnostic tests

• Schiller-Pisarev test

This test is based on determining the level of glycogen in the gum. Its amount increases significantly during inflammation, while healthy gums do not contain glycogen. Lubricating the inflamed gums with Schiller-Pisarev solution gives a color change reaction from light brown to brown. This research method is used to make diagnoses of both periodontitis and gingivitis.

• Assessment of oral hygiene level

A solution (2 g of potassium iodide, 1 g of crystalline iodine, 40 ml of distilled water) is applied to the outer surface of the six lower front teeth.

The assessment is carried out using a five-point system and each tooth is assessed separately:

1. 5 points – complete staining of the entire tooth surface;
2. 4 points – staining of ¾ of the tooth surface;
3. 3 points – staining of half the tooth surface;
4. 2 points - staining of a quarter of the tooth surface;
5. 1 point - absence of any staining of the tooth surface.

Then the scores of all examined teeth are summed up and divided by their number (usually the test is carried out on six teeth). This is how the hygiene index is obtained.

As a result, the quality of hygiene is assessed:

• 1.1-1.5 points – good hygiene index;
• 1.6—2.0—satisfactory hygiene index;
• 2.1—2.5—unsatisfactory hygiene index;
• 2.6—3.4—poor hygiene index;
• 3.5-5.0 - very poor hygiene index.

• Vacuum test according to Kulazhenko

Using a Kulazhenko vacuum apparatus, it is possible to determine the time of hematoma formation when a vacuum is applied to the gum area. Typically, the test is carried out in the incisor area by placing a tube of the device on the gum. The formation of a hematoma in 60 seconds indicates the normal condition of the gums, while the appearance of a hematoma in 29-30 seconds signals an inflammatory process.

• Oxygen tension in gum tissue

The sensor of the device is applied to the gum, and the device records the level of tissue hypoxia. Reduced oxygen tension indicates a prolonged inflammatory process.

Symptoms and consequences

Symptoms of gingivitis are determined by stage. The disease can begin with the following manifestations:

• swelling, redness, looseness of the gums;
• increased sensitivity of tissues, bleeding during brushing teeth and eating due to fragility of blood vessels;
• pain when chewing and touching;
• bad breath.

As the disease progresses, the necks of the teeth may become exposed, which leads to increased sensitivity of the teeth - it becomes difficult to accept hot and cold drinks and foods. The pain also increases over time, and severe difficulty chewing food may occur. In addition to general symptoms, there are also specific ones characteristic of a particular type of gingivitis.

The consequences of gum inflammation can be very serious: the pathological process often spreads to the ligamentous apparatus of the tooth, and periodontitis occurs. This condition is dangerous due to the mobility of teeth and the high probability of their loss. A chronic focus of inflammation in the mouth is a risk factor for the development of diseases of the ENT organs.

Symptoms of gingivitis in adults

To properly treat the pathology, you need to know that the symptoms of gingivitis and treatment are closely interrelated. What helps with the catarrhal form may not be sufficient with the necrotic form. What to do if you are in doubt about what kind of gingivitis you have? Photos from the collections will help in a rough assessment, and then you should go straight to the periodontist’s office.

Common signs of gingivitis:

• Bright red tint of gums (due to dilated capillaries)
• Swelling of the papillae (due to exudation processes)
• Unpleasant odor (halitosis)
• Bleeding (increased vascular permeability)
• Pain when eating (nerve endings are compressed due to swelling)
• Dense plaque and tartar

Important! Chronic gingivitis often occurs together with general pathology. Usually this is an ulcerative lesion of the gastrointestinal tract or HIV infection.

Types of gingivitis

Gingivitis can be acute or chronic. In the first case, noticeable symptoms occur. Chronic forms are characterized by mild symptoms, pain is absent or minimal. Periodic slight bleeding of the gums during brushing and halitosis may occur. It is important to understand that sluggish gingivitis is characterized by periodic exacerbations.

Inflammation of the gums is classified not only by its form, but also by the nature of its course.

Catarrhal gingivitis

Catarrhal gingivitis is characterized by redness of the gum area. Itching and bleeding due to mechanical action and mild pain may occur. This is the most common and easiest to treat type of inflammation. Quite often it acts as the initial stage of development of other forms.

Ulcerative gingivitis

Necrotizing ulcerative gingivitis is characterized by the formation of open ulcers, death of areas of gum tissue, and strong bad breath. One of the typical symptoms is the appearance of a grayish coating. The disease is more difficult to treat; in the absence of timely assistance, purulent foci and severe necrosis may appear.

Hypertrophic and atrophic gingivitis

Ulcerative-necrotic gingivitis is followed by hypertrophic gingivitis - excessive growth of tissues occurs that cover the crowns of the teeth. There is keratinization of areas of the gums.

The atrophic form of the disease, on the contrary, is characterized by a decrease in the level of the gums and exposure of the necks of the teeth. This condition is dangerous due to the loss of healthy teeth.

Desquamative gingivitis

This type of inflammation is characterized by abundant desquamation of the gum epithelium. Distinctive features are pronounced redness and noticeable peeling areas of the surface of the mucous membranes.

Hypertrophic gingivitis –

Hypertrophic gingivitis is a variant of chronic gum inflammation.
With it, there is an increase in the volume of the gums, which can occur either due to persistent chronic swelling of the gums (which practically does not respond to anti-inflammatory therapy), or due to its fibrous growth. The hypertrophic form of gingivitis most often occurs only on the front surface of the teeth. Causes of occurrence - most often occurs with endocrine disorders, toxicosis of pregnant women (gingivitis of pregnant women), with hormonal changes in adolescents (juvenile gingivitis), as well as with malocclusion and in the presence of local traumatic factors - overhanging edges of fillings and crowns. In some cases, gum hypertrophy is a consequence of long-term chronic catarrhal gingivitis.

Hypertrophic form of gingivitis: photo

Hypertrophic gingivitis - symptoms and treatment will depend on the form of this disease, i.e. depending on what exactly causes the gum enlargement (edema or fibrous growth). In accordance with this, edematous and fibrous forms of hypertrophic gingivitis are distinguished.

• Edema form (Fig. 16-17) - the gingival papillae in this form are enlarged not due to tissue proliferation, but due to their swelling.
  Accordingly, they will not be dense, but loose. It is this form of gingivitis that most often develops in pregnant women and adolescents against the background of hormonal changes. At the beginning of treatment, it is necessary to remove dental plaque and anti-inflammatory therapy. If the effect of these measures is insignificant, then sclerosing therapy is used, when, against the background of pain relief, a sclerosing solution is injected into the swollen gingival papillae. Typically, solutions of 40% glucose, 25% magnesium sulfate, 10% calcium chloride are used. 0.1-0.2 ml of solution is injected into each papilla. Course – 3 or 4 injections into each gingival papilla. The intervals between series of injections are usually 1-2 days. If the effect of such therapy is absent or insufficient, prednisolone is injected into the gingival papillae.

• Fibrous form (Fig. 18, 19) - the gingival papillae in this form are dense, and not loose as in the edematous form. This is due to the fact that the increase in gum volume did not occur due to swelling, but due to the proliferation of fibrous connective tissue. Treatment begins with the elimination of traumatic factors (overhanging edges of fillings, crowns, and also in the case of a traumatic bite - selective grinding of teeth). At the same time, dental plaque is removed.
  The main method of treating the fibrous form is surgical excision of gum tissue (Fig. 19-21). After excision, a course of anti-inflammatory therapy is prescribed, for example, therapeutic dressings with heparin ointment, hydrocortisone and other drugs. It should be noted that in the absence of treatment, the long-lasting edematous form of hypertrophic gingivitis can easily turn into fibrous.

  Surgical excision of the gum –

Diagnostic features

Gingivitis can be recognized visually—sometimes one examination by a doctor is enough. But you should make sure that there are no more serious pathologies, so diagnosis may include not only a visual assessment of the condition of the oral cavity, but also other measures:

• collecting anamnesis, assessing the condition of structures in the oral cavity;
• probing of periodontal pockets if present;
• determination of tooth mobility;
• electroodontodiagnosis to determine the condition of the dental pulp;
• panoramic x-ray or targeted x-ray - to exclude periodontitis, periostitis and other pathologies of deep structures, jaw bone tissue, etc.

It is important to take into account the presence of chronic diseases and medications. Only with complete information can a doctor make an accurate diagnosis and develop an effective treatment regimen.

Classification of gingivitis according to intensity

• easy
• average
• heavy

The severity of the flow is determined3:

The degree of manifestation of general symptoms - weakness, fever, the presence of enlarged lymph nodes. Changes in condition are also reflected in blood tests. With a mild form, the temperature rises to 37.5°C, with a moderate form up to 38°C, with a severe form - up to 40°C.

Principles of treatment

Treatment of gingivitis begins with hygiene: professional teeth cleaning. It is important to remove soft and hard dental plaque. For this, hand tools, an ultrasonic scaler, and the powder blasting method can be used. Subgingival dental plaque can be removed using the Vector device.

It is important to eliminate foci of infection - to fill teeth affected by caries, to undergo endodontic treatment in the presence of pulpitis, to remove the roots of teeth that cannot be restored and are not involved in the prosthetic process.

It is necessary not only to pay attention to the causes of the disease, but also to reduce the influence of harmful factors:

• stop smoking;
• consume food and drinks only at a comfortable temperature;
• remove spicy and smoked foods, marinades, especially those with vinegar, from the diet;
• During the treatment period, try to eat less solid food so as not to injure the loose gum tissue.

If the source of injury to the mucous membrane is the sharp edges of teeth or dentures, the doctor will immediately take measures to prevent further damage or recommend contacting a dentist of another profile - an orthopedist, an orthodontist.

Diagnosis of necrotizing ulcerative gingivitis

Diagnosis is made through the clinical manifestations of necrotizing ulcerative gingivitis.7,8

During the examination and questioning, the dentist identifies poor hygiene, bleeding gums, poor general condition and the absence of gum pockets (impaired attachment of the gum to the tooth). Be sure to take a panoramic photograph of all teeth to distinguish ulcerative gingivitis from periodontitis.

Additionally, bacteriological examination and the ELISA method can be carried out to confirm the diagnosis, determine the level of immunoglobulins and select appropriate treatment tactics.

It is important to distinguish ulcerative gingivitis from immunodeficiency conditions and blood diseases. For this purpose, if necessary, other tests may be prescribed.

Drugs for the treatment of gingivitis

Treatment for gingivitis may involve the use of medications in different forms. Mouth rinses based on antiseptics allow you to solve two problems at once: mechanically remove food debris and bacterial plaque, and also deliver active ingredients to inflamed tissues. Dentists recommend using ready-made pharmaceutical products; in each specific case, a specialist will prescribe a medicinal solution to quickly alleviate the condition. Ready-made formulations are more convenient to use, and the concentration of active components in them is known, this distinguishes them from traditional methods.

The most popular are rinses based on the following antiseptics:

• chlorhexidine;
• furacillin;
• chlorophyllipt;
• Metronidazole.

Calendula, chamomile, yarrow, oak bark, and St. John's wort have antiseptic properties. Doctors do not recommend preparing alcohol infusions; it is better to choose decoctions. The recipes call for using one teaspoon of dry raw materials per glass of boiling water. It is important to cool the broth to a comfortable temperature. Take into account possible allergic reactions, give preference to those herbs to which there was no previous intolerance. It is necessary to discuss with your doctor the possibility of using traditional methods.

Effective drugs for the treatment of gingivitis are ointments and gels. Multicomponent local products for applications not only help relieve inflammation, but also have an analgesic, decongestant, and antipruritic effect. The active components of such drugs can be lidocaine, antibacterial, antifungal substances, and antiseptics. The doctor will select a gel or ointment taking into account the shape and type of gingivitis. Thus, for ulcerative inflammation, it may be advisable to use regenerating agents, and acute catarrhal gingivitis will require the use of a powerful anesthetic gel.

For hypertrophic gingivitis, surgery may be required - a simple gingivectomy. This operation involves excision of excess tissue and application of a bandage, and is performed under local anesthesia.

Why is inflammation of the gums near the teeth dangerous?

Childhood gingivitis develops very quickly, since there are many prerequisites for this - from child abuse of sweets to insufficient oral hygiene. After the start of the process, the volume of actively multiplying pathogenic microflora quickly increases. On the second or third day, you can already notice the first signs of beginning mucosal erosion. If you do not seek help at this time and start the disease, the already matured child will suffer from gum problems all his life and may lose his teeth prematurely.

Preventive measures

Prevention of gum disease consists of maintaining oral hygiene at home, as well as regular professional cleanings. You need to visit the dentist twice a year, promptly treat dental diseases, replace old fillings and dentures.

One way to prevent gingivitis is to eat a balanced diet. It is important to eat right, choose foods and drinks that are warm or at room temperature. Do not ignore the importance of using dental floss and mouth rinses after every meal.

Dentists at STOMA clinics know how to treat gingivitis: the accumulated experience, advanced diagnostic and therapeutic methods in the arsenal of our specialists allow us to provide urgent dental care to patients and develop effective treatment regimens.

About tooth loss and how to avoid it

Last year, we, at Star Smile, released a cartoon video in which the heroine was thinking about what to do - either start bite treatment when she was young, or wait until all the teeth begin to decay. Here he is, by the way

The video received quite a lot of views and responses, many patients asked us to continue the topic of consequences - to show readers what inattention and carelessness when caring for teeth and gums can lead to. Therefore, we will continue to educate you and hope that our articles will help you contact doctors in a timely manner and avoid most of the problems that we write about.

Why do gums become inflamed?

The main cause of inflammation is the same in both adults and children - poor oral hygiene, that is, insufficient quality of teeth cleaning. In children, additional factors also play a significant role:

1. In the youngest children, gingivitis occurs during teething;
2. the cause may be malocclusion in children, causing uneven distribution of the chewing load;
3. gums become inflamed due to a lack of vitamins and minerals in the child’s body;
4. inflammation is provoked by advanced caries and its unprofessional treatment - in particular, incorrectly installed fillings that constantly injure the mucous membrane;
5. the presence of chronic diseases also affects;
6. Children with weakened immune systems suffer from gingivitis.

Conventionally, gingivitis that occurs during the eruption of primary or permanent teeth and the formation of dental roots can be called a physiological norm. In all other cases, professional diagnosis and consultation with other medical specialists are necessary to help identify the cause of gum inflammation in children and carry out effective treatment.