The Catarrhal gingivitis, treatment of chronic catarrhal gingivitis
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Catarrhal gingivitis


Catarrhal gingivitis

Catarrhal gingivitis

Catarrhal gingivitis is one of the forms of gingivitis that occurs as a consequence of the pathogenic action of pathogenic microorganisms and products of their vital activity, that is, hard and soft dental deposits. The disease is exudative (accompanied by the release of fluid from the gingival pocket).

The catarrhal form of acute gingivitis is characterized by transience and surface manifestation of symptoms (inflammation does not go beyond the mucous coating of the gum).

Common signs of inflammation are present in the symptoms of this disease:

  • Pronounced edema
  • Hyperemia of blood vessels (arterial and venous) in the subepithelial connective tissue
  • Inflammatory infiltrate in the tissues contains leukocytes
  • Tissue structures remain without significant changes.

Exacerbation of the chronic form of catarrhal gingivitis is already considered the initial link on the way to the appearance of periodontitis. The study reveals a whole complex of background structural changes in tissues.

The change in the structure of the affected tissues is associated with the occurrence of trophic disorders with repeated, sequential exacerbations of the inflammatory disease.

During the exacerbation the connective stroma gradually thickens, sclerosing. Sclerosis is also subjected to vessels in the place of localization of the pathological process.

The nature of the inflammatory fluid in the tissues during exacerbation is more dense. There are more neutrophils and eosinophils in its composition, and macrophage lymphocytes become smaller.

At the peak of the inflammatory process, leukocytes are found in the epithelial covering of the gum. They are few and this fact does not lead to significant changes. But with a microscopic examination, it becomes clear that the white blood cells are reaching the surface of the gingival mucosa. This is the cause of the appearance of a white coating on the mucosa of the alveolar process in catarrhal gingivitis.

Causes of catarrhal gingivitis

The root cause of chronic catarrhal gingivitis is poor hygiene of the teeth and oral cavity. Together with the fact of the lack of adequate and timely treatment, the disease quickly passes from a localized (limited) to a generalized form (spreading over the entire surface of the gums of the upper and lower jaws).

A soft plaque is deposited in the place where the gum rests against the crown of the tooth. This is a favorable area for feeding and multiplying bacteria, since a small depression holds up food leftovers and is poorly cleaned by a toothbrush.

There are several reasons for the accumulation of plaque in this area:

  • Inadequate hygiene of teeth and oral cavity
  • Change in the composition and / or amount of saliva released
  • Pathology of occlusion (crowding of teeth, orthognathy, prognathia)
  • Decrease in the level of body immunity
  • Wearing orthopedic or orthodontic

All these situations have one result: the balance between the active effect of the pathogenic flora on the soft tissues of the periodontal disease is disturbed, the preponderance is in the direction of microorganisms. As a result, there is an inflammatory reaction of the gums in the form of gingivitis.

The mechanism of development of catarrhal gingivitis

The development of this form of gum disease occurs in several stages:

  1. Over the gum and in the periodontal pocket (a small space between the marginal part of the gum and the crown of the tooth), a soft coating accumulates.
  2. Bacteria penetrate into the gum tissue and cause the development of the inflammatory process.
  3. The parodental pocket widens and deepens, as the gingival margin swells, and the ligaments of the tooth become weaker.
  4. The supply of gum tissue is disrupted, the blood supply of the capillaries becomes less intense. Local immunity is significantly weakened, which creates favorable conditions for the further development of pathogenic flora.

Thus, there is a vicious circle, which can be broken only by passing the appropriate treatment in the office of the periodontist.

Symptoms of catarrhal gingivitis

Symptomatics of catarrhal gingivitis is sufficiently pronounced, so it is quite easy to conduct correct diagnosis.

Patients with this type of gum disease often complain about:

  • Unpleasant itching in an inflamed area
  • Bleeding of periodontal tissues when cleaning teeth and from eating solid foods, as well as causeless bleeding in the morning
  • The presence of a large number of dental calculi on all teeth
  • Unpleasant odor from the mouth

Inflammation often occurs in young people and children. The development of the pathological process proceeds slowly, with poorly expressed symptoms. The general condition of the body is not subject to pathological changes.

When examining the oral cavity, you can see:

  • The presence of a large number of mineralized and non-mineralized dental deposits
  • Inflammation of the gums that has already passed into the chronic stage and is marked by redness, swelling and bleeding with mechanical action on soft tissues
  • Pathological mobility of teeth is not observed

X-ray examination is not informative, as the bone tissue in catarrhal gingivitis is not destroyed.

Acute stage of the disease

At the initial stage, the disease has all the signs of a primary inflammatory process.

The gums are painted in bright red color, the surface of the mucous membrane is edematic, glistens and when blood is applied to the gums when it touches the gums.

Acute catarrhal gingivitis has three degrees of severity:

  1. An easy degree, which is characterized by the spread of the inflammatory process only to the entire surface of the gingival papillae.
  2. With the transition to an average degree of soft tissue damage extends to the entire marginal gingiva.
  3. The severe degree is easily differentiated by spreading the inflammation to the entire surface of the mucosa, which covers the jaws, without going to the sky, the bottom of the mouth and cheeks.

Features of the stage of exacerbation

Exacerbation of the chronic stage of catarrhal gingivitis in the autumn or spring period is quite frequent, since all kinds of chronic diseases tend to exacerbate at this time.

Complaints when exacerbating the pain in the gums, the taste of blood in the mouth and increase the degree of bleeding periodontal tissue.

An objective examination helps identify the following symptoms:

  • Congestive hyperemia of the gingival mucosa
  • With easy probing, bleeding may begin
  • Soft tissues have a cyanotic (cyanotic) hue
  • The thickening of the gums is cylindrical
  • On all teeth of the upper and lower jaws - a layer of soft plaque, supragingival and subgingival mineral deposits

In the event that the patient neglects to seek help in the dental office during the period of exacerbation, the symptoms gradually become less pronounced, the disease again passes into the stage of remission.

Perhaps some people who suffer from chronic catarrhal gingivitis have a false idea that the disease is completely lost, then returns. In fact, the infection continues to destroy the soft tissues, exacerbating the pathological condition of the gums. In the absence of adequate treatment, complications may develop.

Diagnostics and differential diagnostics

Diagnosis of catarrhal gingivitis is not difficult.

Careful collection of anamnesis (questioning the patient), instrumental and visual examination of the oral cavity provides a fairly clear picture so that a specialist can confidently recognize the signs of catarrhal gingivitis.

Anamnesis is limited to asking a patient about the duration of the disease, the manifestation of symptoms, as well as his subjective sensations.

Instrumental examination is reduced to probing the gingival pockets, determining the presence or absence of abnormal mobility of the teeth and performing an X-ray examination of the integrity of the bone tissue of the alveolar processes (if there are any doubts about the reliability of the diagnosis).

Differential diagnosis is performed with other types of gingivitis and special pigmentation of the marginal gingiva in representatives of Arab nationalities.

After the final diagnosis, the periodontist proceeds, directly, to the treatment process.

Treatment of catarrhal gingivitis

The treatment process is carried out strictly in accordance with the following stages:

  1. Professional cleaning of the oral cavity with the removal of mineralized (supragingival and subgingival) and non-mineralized dental deposits. Removal of stones and plaque is carried out with the help of a scaler or sandblaster. After cleaning the surface of the teeth, it is necessary to polish with a special paste and brush, as well as rubber tips and polishing discs. Polishing is an obligatory measure, as microscopic remains of stones create favorable conditions for the rapid accumulation of a new layer of plaque.
  2. Oral baths with 0.06% chlorhexidine solution for ten days lasting three minutes in the morning and in the evening.

After removing especially severe symptoms and relative normalization of the gum condition, it is advisable to conduct a course of physiotherapeutic procedures:

  • Massage
  • 10 sessions of hydromassage
  • Electrophoresis with the duration of one session - 20 minutes, the number of 12-15 procedures. Electrophoresis with an ascorbic acid solution of 5% and an aminocaproic acid solution of 5%
  • Laser therapy of the marginal part of the gum
  • Darsonvalization
  • Phonophoresis

Treatment of acute catarrhal gingivitis or acute stage of the disease, the patient should be prescribed medications with antipyretic, desensitizing and restorative properties. It is also desirable to take complex vitamins.

If the patient has a concomitant disease of a general nature, all the actions of the therapist and the periodontist should be coordinated among themselves.

| 27 December 2014 | | 1 355 | Stomatology