Hypertrophic gingivitis: causes, symptoms, diagnosis and treatment

Among all pathological inflammatory processes in the gum area, hypertrophic gingivitis is a relatively rare disease. Its essence lies in excessive proliferation - hypertrophy and proliferation of the covering gums of the mucous membrane.

Sometimes it is expressed so strongly that it prevents normal chewing food - the gingival epithelium "swims" not only on the neck of the teeth, but also on their crowns.

Although the growth occurs due to the basal epithelium of the interdental papillae and does not reach the cutting edges of the teeth, but the resulting structures are soft and loose, damaged by chewing and food, and pressing against hard dental cover.

In turn, damage to the epithelium causes even more rapid growth, and irritated tissue is protected from infringement of its rights to free unhindered development, increasing mass.

Unlike other forms of gingivitis in this chronic inflammatory process, which does not change the structure of the alveolar bone tissue, the strength of the joint of the teeth with the gums is not weakened, despite the formation of false dentogingival pockets.

Provoking factors

To develop such a pathology can either for reasons of local, local, due solely to the state of the dentoalveolar system and oral mucosa, or for reasons of general, Your system.

The first group of causes can be attributed to:

• bite disorders, or diseases of the teeth themselves - in the form of their twisting, crowding or overcomplex, and abnormalities of the bridles( low bridles);
• injuring gums factors or in the face of poorly executed or worn out orthodontic designs, seals, prosthetic teeth, or in the form of deposits of tartar, plaque.

To the second category of factors contributing to the onset of this disease, belong:

• chronic health disorders in the form of endocrine, nervous diseases, leukemia;
• aftereffect of prolonged use of medications - hormones, immunosuppressors, oral contraceptives;
• arising for various reasons( pregnancy, pubertal age or otherwise) hormonal balance disorders ;
• deficiency of ascorbic acid , largely responsible for the condition of the gums.

Most often, hypertrophic gingivitis develops on the basis of a long-term catarrhal form of the disorder, and may be a symptom of generalization of periodontitis, and may be an independent nosological form.

About forms and stages of

Hypertrophic gingivitis can occur in the following forms:

• edematous or fibrous,
• have the appearance of acute or chronic process,
• differ in the degree of hypertrophy of the gingival mucosa,
• be localized or generalized.

These signs are based classification of hypertrophic gingivitis, also called hyperplastic.

If the edematous form of hypertrophic gingivitis manifests itself in addition to the swelling and loosening of the mucosa of the interdental papillae by pronounced flushing of the gums, their bleeding and soreness, the fibrous form is characterized by the absence of inflammation: no bleeding, soreness, discoloration of the gums, and only the volume of the gingival mucosa changesin the direction of a significant increase in it.

In accordance with the volume of gingival hypertrophy, 3 levels of process activity are distinguished:

1. With the first level of is the active growth of the edge of one or both gums with a noticeable increase in the height and width of the interdental papillae, and their teeth are closed by no more than 1/3.
2. The second level of is characterized by the continued thickening of the edge of the gum and its papillae with the acquisition of a dome-like configuration, the crown of the teeth is half hidden by the proliferating mucosa of the gums.
3. With , the third level of activity, the proliferation of gums and their papillae reaches a maximum - the teeth are hidden by over half the height of the crowns, almost to the area where the teeth are closed, the interdental papillae completely covered with painful, easily bleeding granulations.

A localized process is the spreading of a painful process to an area containing no more than 5 teeth, the generalized process is called spreading it to a larger area, up to the involvement of all gums.

Symptomatic of the disease

Hypertrophic gingivitis manifests itself in various degrees of swelling of the gingival tissues, their burning or other painful response to food processing cold, hot, containing acidic components. The gums are hyperemic to a varying degree and bleed easily not only when eating and cleaning their teeth, but also from touching, and also differ not in aesthetically pleasing appearance.

If gingivitis occurs in a swollen form, then to the forefront complaints are raised about the high sensitivity of the teeth, the varying degree of soreness of the gums with their slight bleeding even with a slight effect, and an impartial picture of the state of the oral cavity.

The dentist reveals hyperplasia and puffiness of the interdental papillae, bright hyperemia with a cyanotic shade of glossy gums, and slight bleeding, especially when probing false dentogingival pockets in which soft or hard dental deposits and the indispensable integrity of the dental epithelial junction are found.

Complaints of a patient with a fibrous form of hypertrophic gingivitis are a complaint about the depressing appearance of the oral cavity with the increase in the mass of the gums, their appreciable density, difficulty in chewing food.

In the case of dental examination, with a characteristic tuberculate, uneven gingival surface of the natural pale pink color, painless, do not bleed during probing, revealing the presence of subgingival deposits, formed as a result of the difficulty of carefully caring for the teeth that have changed their condition.

Diagnostic criteria and differential diagnostics

To exclude the error in the diagnosis, differential diagnosis of hypertrophic gingivitis with similar gum conditions in periodontitis, epulis, fibromatosis is carried out.

To help diagnose and differentiate from similar pathologies, a number of dental tests can be performed - Schiller-Pisarev tests - and measurement of indices:

• hygiene;
• periodontal;
• papillary-marginal-alveolar.

X-ray methods are used from X-ray methods:

• panoramic;
• intraoral;
• orthopantomography.

With a long-term process, it is possible to detect porosity in the image of the apical areas of the interdental septa, usually similar pathology studies do not reveal.

In difficult cases, biopsies of gum tissues are resorted to, followed by a morphological study of them.

The presence of diseases and conditions that can cause the development of gingivitis, requires the advice of appropriate specialist doctors: endocrinologist, gynecologist, hematologist.

Methods of treatment depend on the form of the disease.

. Possible influence on the proliferation of the gingival mucosa in two ways: conservative - therapeutic or surgical - surgical.

The first method involves identifying or accounting for possible causes of the disease, and the emphasis is on their elimination and correction of the changes in the state of the organism that have occurred as a result of their effects.

So, if thyroid gland pathology or diabetes is used, adequate treatment of the underlying disease is appropriate, if hypertrophic gingivitis develops in pregnant women or adolescents, then correction of the regime with the addition of necessary medical components and preparations for the correction of hormonal disorders is necessary.

At the beginning of any treatment, a necessary condition is the sanitation of the oral cavity with professional cleaning and disinfection of teeth, gums, with the removal of dental deposits and faulty orthopedic structures and the application of measures to clean up the teeth.

Depending on the extent of their neglect, this is a filling, removal, or other treatment to prevent further injury to the gums.

A separate stage is bite correction, so participation in the treatment process of an orthopedic dentist is just as necessary as a dentist, a periodontist, a hygienist.

Parallel with the elimination of the causes of hypertrophic gingivitis and correction of the changes caused by it, the effect directly on the disease is effected by the methods of systemic and local therapy.

Depending on the form of hypertrophic gingivitis treatment will differ in detail.

Edema

In edematic form, the emphasis is on reducing inflammatory and exudative processes in the tissues of the gums. Therefore, the drugs used in systemic therapy are anti-inflammatory, as well as antibacterial and other antiseptic agents that suppress the microbial and other pathogenic flora, and drugs that reduce vascular permeability, leading to loosening of the mucous gums.

To achieve these goals, both oral and topical antiseptic substances are used in the form of rinses, applications, and baths for the oral cavity. It is used rubbing the papillae of hormone-containing ointments into the papillae, or injecting steroid hormones into them.

For the same purpose, physiotherapeutic local effects with iontophoresis, galvanic currents and Darsonval currents, ultrasound, as well as laser therapy and gum massage are used.

To reduce exudation, ascorbic acid in combination with vitamin E is used in combination with vitamin E.

In the absence of the effect of local measures to eliminate inflammation, sclerosing therapy is used as injections into the interdental papillae of solutions of calcium salts( gluconate or chloride), hypertonic solutionglucose, ethanol solution, conducted under local anesthesia.

Fibrous form

Since there are no acute inflammatory phenomena in fibrotic hypertrophic gingivitis, the measures applied to it will be different than in the swelling form.

This effect on the aggressively spreading tissue by cryodestruction, or the application of diathermocoagulation to the hyperplasia of the gingival papillae.

When there is no other choice, the method of gingivectomy is applied - excision of a part of the gum together with the site of hyperplasia of the mucous membrane.

As in the case of edematous form, fibrotic measures require measures of oral cavity sanitation and orthodontic measures, including restoration of teeth, bite and similar measures to eliminate chronically traumatic factors.

In some cases, a plastic surgeon is required to repair defects in the frenum of the lips and tongue.

Innovative methods of

New methods of influencing the gingival mucosa in this disease are used:

• excision of "plus-tissues" with a scalpel laser , replacing the traditional surgical;
• method paraffinotherapy with the application on the gum of the paraffin, heated to the required temperature, providing compression of tissues, reduction of edematous phenomena stimulating the regeneration of the gums by normalizing the blood supply in them;
• method piocide therapy consists in cauterizing excess tissue with a mixture of ether and sulfuric acid at the first and second degrees of fibrous gingivitis;
• leveling and grinding of tooth surfaces are now performed with ultrasound tools .

Relapse prevention

The consequences of hypertrophic gingivitis depend on how radically eliminated the reason for its resumption after the therapy. If it is just temporarily "pushed aside," the painful condition can resume.

So, a relapse can arise at approach of pregnancy, hormonal jumps in a climax or owing to an exacerbation obshchematicheskoj a pathology.

Therefore, it is necessary to regularly visit both the dentist's office and other specialists ready to adjust the changes that have arisen in the body.

No less important are the measures of prevention of both the disease and its relapses, the main one being the content of the oral cavity in a proper hygienic state - and here the specialist's help is simply indispensable!

But with juvenile gingivitis, the disease most often passes with the restoration of the hormonal balance in adulthood, surgical intervention usually without requiring. However, even at this time of life, dental consultation is mandatory.