- Causes and mechanism of hypertrophic gingivitis
- Symptoms of hypertrophic gingivitis
- Forms of hypertrophic gingivitis
- Degrees of severity of hypertrophic gingivitis
- Place of localization and phase of the disease
- What diseases can be confused with hypertrophic gingivitis?
- Treatment of hypertrophic gingivitis
Hypertrophic (or hyperplastic) form of gingivitis can occur as an independent nosology, but, in some cases, is a disease that accompanies periodontitis.
Pathological changes are expressed in the increase in the volume of soft gingival tissue and their uneven growth. The disease is characterized by a chronic course with exacerbations, which occur quite often.
Hypertrophic gingivitis changes the structure of tissue elements. Epithelium (the upper layer of the mucous membrane) thickens unevenly, forming a peculiar foci of dense epithelium. The connective tissue, which is located on the epithelium, also thickens like a string. In all layers of the tissue, edema develops and hyperemia appears. In the intercellular fluid, leukocytes and macrophages are found.
Causes and mechanism of hypertrophic gingivitis
Chronic form of the disease is accompanied by a rapid increase in the number of basal cells of the epithelial gum layer due to their active growth. As a provocative factor, hereditary anomalies of the TMJ (temporomandibular system), disruption of the endocrine system of the body and iatrogenic causes in the form of an improperly applied seal appear.
The main etiological factors contributing to the development of this pathology are:
- Hormonal disorders
- Acceptance of certain medications (eg, Difenin and Ciclosporin, prolonged use of oral contraceptives)
- Diseases of the hematopoietic system
- Lack of vitamin C
- Prosthetics performed in violation of the rules of anatomy and physiology of the oral cavity.
Hyperplastic gingivitis affects almost half of those who took Hydantoin and suffer from epileptic seizures.
Symptoms of hypertrophic gingivitis
In the area of localization of pathology, the gum extends. With the mucosa, which normally has a pale pink color, significant changes occur. When palpation, swelling and redness are felt.
The histological picture is often not informative.
Hypertrophic gingivitis may occur at a time when a person is ill with leukemia leukemia. Leukemia affects the body when the immune system is lowered. This activates local bacterial flora due to changes in autoimmune and toxic processes.
In the case where leukemia and hypertrophic gingivitis occur in parallel, the gums become so sensitive that each touch responds with pain. Painful sensations can disturb the patient even at rest. Also characteristic is an increase in the size of the gingival papillae and bleeding during mechanical exposure.
Forms of hypertrophic gingivitis
There are two forms of the disease:
- . Ointment hypertrophic gingivitis . The gingival papillae are swollen, hyperemic and have a bluish tinge. There is an induced bleeding, false dentogingival pockets are formed. The surface of the mucous glistens like gloss. When pressing on the gingival papilla, a small dent remains with the blunt end of the probe. This suggests that the gum tissue is impregnated with intercellular fluid. Patients complain about the aesthetic appearance of the gums, frequent bleeding, the emergence of pain during dental cleaning or during meals.
- (или фиброзная гиперплазия десен) характеризуется не отеком, а разрастанием тканей десны. Fibrous hypertrophic gingivitis (or fibrous gingival hyperplasia) is characterized not by swelling, but by the proliferation of gum tissue. The gingival papillae become dense to the touch, false dentogingival pockets are formed, bleeding is absent. The mucous membrane in the lesion does not change color, but under the gum and above it is found a large number of soft and hard dental deposits. Complaints in patients arise on the ugly appearance of the enlarged gingival papillae.
Degrees of severity of hypertrophic gingivitis
Depending on what part of the crown of the tooth covers the hypertrophied gingiva, three degrees of severity of this gingivitis are distinguished.
- Gipertrophic gingivitis occurs in mild form, if the edge of the gum covers the crown no more than 1/3 of the tooth height.
- The average severity is manifested by a more pronounced form of gingival tissue hypoplasia. In this case, the crown of the tooth is hidden almost half its height.
- With a severe form of the disease, 2/3 of the crown of the tooth is covered with an overgrown gum.
Place of localization and phase of the disease
The most common hypertrophic gingivitis is found in the area of the gum site, which covers the alveolar process of the incisors and canines of the upper jaw. A similar, selective lesion of periodontal tissues is called a localized form of gingivitis.
But there is also a generalized form, when the pathological process captures the entire jaw or even both.
What diseases can be confused with hypertrophic gingivitis?
In order not to be mistaken with the diagnosis, the doctor-periodontist should carefully collect the anamnesis (a detailed interview of the patient and examining the condition of his gums).
In the diffodiagnosis of gingivitis from periodontitis, the circumstance that, in periodontitis, bone resorption always occurs to a greater or lesser degree helps. With gingivitis, the alveolar process of the jaw remains intact. Only the gums are deformed. For complete certainty, you can examine the patient with an X-ray machine. The picture will clearly show if the jaws are partially broken, or not.
With periodontal disease, there are also destructive changes in bone tissues, but the marginal gingiva remains pale pink and has no signs of an inflammatory process.
It is necessary to carry out diffodiagnosis of gingivitis among themselves, since there is a probability of setting up an inaccurate diagnosis. A special feature of the catarrhal type of the disease can be considered a gum that is enlarged in volume, hyperemic, but not overgrown. With hypertrophic gingivitis, the gingiva swells, turns red, and grows. Ulcerative gingivitis is characterized by ulceration of the entire marginal margin of the gum. Ulcers bleed, there is pain syndrome.
Treatment of hypertrophic gingivitis
To determine the appropriate treatment option, it is necessary to find out the root cause of the disease. After determining the etiologic factor, the doctor proceeds to the next stage of treatment: conducts professional hygiene of the oral cavity and teeth.
Cleaning is carried out with a scaler and a sandblaster. To apply the finishing touch, polishing paste, polishing discs and rubber heads are used.
A variant of the development of events is possible, in which the gum becomes inflamed under the influence of foreign objects in the oral cavity. This is facilitated by:
- Wrong orthopedic constructions
- Poorly applied filling or sharp edge of carious tooth.
If hypertrophic gingivitis has arisen because of hormonal disorders, then the patient needs to be treated by an endocrinologist. It is possible that with the restoration of the normal balance of vitamins in the body, signs of hyperplasia of the marginal gingival will disappear.
The complex of conservative measures includes the appointment of anti-inflammatory drugs and medications to the patient to reduce the degree of vascular permeability. In addition, complex vitamins are prescribed.
Physiotherapy has a good effect in its correct conduct. The introduction of calcium gluconate or heparin by electrophoresis, the course of darsonvalization and gum massage can speed up the healing process several times.
Unfortunately, hypertrophic gingivitis does not always give in to conservative methods of treatment. In most cases, the third stage remains indifferent to medications, and the specialist has nothing else to do but to remove the pathologically enlarged gingival papillae surgically.
Operative intervention is carried out under local anesthesia (in the absence of indications for general anesthesia) and is called "gingivectomy." The enlarged gingival papillae are excised, leaving only the part that should be in a healthy person.
Prevention of pathological process
Preventive measures do not imply the commission of any difficult or unusual actions. Requirements consist of several simple rules:
- Regular oral and dental hygiene
- Professional cleaning with removal of all dental plaque once in six months
- Use of floss after eating
- The use of rinsers and therapeutic ointments in the form of coursework and only after consulting a doctor
Gingivitis is considered an inflammatory form of the disease, but it is not transmitted by contact with a sick person. Nevertheless, keeping away from the sick is worth it. Gingivitis can be just an accompanying condition if the patient has more serious problems with the body.