Gingival Necrosis

Necrosis of the gum is pathology, which indicates the death of tissues. Consider the main causes of the disease, symptoms, diagnostic methods, as well as treatment and prognosis for recovery.

Necrosis is a pathological form of cell death, which leads to the death of tissues and parts of organs in the living body. The peculiarity of the ailment is that in the early stages the symptoms are blurred and difficult to diagnose. Necrosis of the gum may arise due to injuries, medical manipulations in the treatment of teeth, as well as in case of disruption of the functioning of the body due to a chronic or acute form of infection, intoxication, vitamin deficiency and other pathologies.

Exposure to chemicals, high or low temperatures, impaired blood composition, harmful microorganisms and a number of other factors increase the risk of developing the disease. Many dental diseases contribute to its development. If you have bleeding gums, bad breath and loose teeth, this may indicate the development of necrosis. For example, such diseases as gingivitis, without proper treatment develop into a chronic form, which causes ulcerative lesions of the gums and, of course, the death of tissues.

The danger of necrosis is that this is an irreversible process, that is, the lost cells do not regenerate. But with timely access to medical care, you can stop the spread of the disease. If this is not done, then progressive necrosis leads to a complete loss of the masticatory function.

[1], [2], [3], [4], [5]

Causes of gingival necrosis

The causes of gingival necrosis are very diverse. The disease can occur due to mechanical effects, injuries, prolonged exposure to cold or high temperatures, or due to clasped blood vessels. Dying of gum tissue occurs due to a violation of normal blood flow to the cells of the affected area. Very often, gum lesions are accompanied by necrosis of the teeth.

Dentists identify traumatic, ischemic, trophoneurotic and toxicogenic origin of gingival necrosis. The ischemic form of pathology arises as a result of circulatory disorders, and trophoneurotic due to a violation of innervation of gum tissue. Consider the main causes of gingival necrosis:

• Poor hygiene of the cavity leads to bleeding and swelling of the gums, destruction of the attachment of the tooth to the gums and tissue necrosis.
• Regular injury to tissues due to treatment or prosthetics leads to a violation of blood circulation and dying of the gum. Mechanical injury due to incorrect bite, causes inflammation, and in the neglected case, and necrosis.
• Hormonal disruptions, blood diseases and a number of other pathologies of the endocrine nature lead to dental diseases, which, without due treatment, grow into necrosis.

[6], [7], [8], [9], [10], [11], [12], [13]

Necrosis of the gums from arsenic

Necrosis of the gums from arsenic is a fairly common problem that many patients of dental clinics face. Until now, dental practice uses anhydrite arsenic acid in the form of a paste. The substance is used to devitalize the pulp of the tooth. That is, to remove coronal or root pulp with complete destruction of all structures and functions of this tissue. The depth of destruction depends entirely on the dose of arsenic paste and the duration of its action. Such treatment is used for pulpitis (chronic and acute diffuse) with curved or impassable roots in elderly patients, with fibrotic pulpitis, limited mouth opening, or allergic reactions to local anesthetics.

Arsenic is a chemical element from the nitrogen family. 5-50 mg of this substance is considered a toxic dose for the human body. The mechanism of toxic action is directly related to metabolic disturbances. Since arsenic refers to protoplasmic poisons, it interacts with sulfhydryl groups. Oxidation processes lead to local tissue destruction. The main targets of arsenic: skin, kidneys, gastrointestinal tract, bone marrow and lungs.

Prolonged exposure to arsenic causes toxic changes in the periodontitis of the tooth and necrosis of the gum. If the arsenic paste is not hermetically sealed with a temporary seal, then the substance will leak out and cause necrosis of the gum, and later the death of bone cells, that is, osteonecrosis. The danger of the latter pathology is that it has a chronic and progressive course. So, the duration of an ailment can be from 1 to 10 years, and at first the disease runs unnoticed. But in the future, the patient suffers from severe pain in the bone and neuropathy.

Symptoms of gingival necrosis

Symptoms of gingival necrosis have several stages of development, each of which is characterized by clinical manifestations. Let's consider the basic symptomatology of necrotic changes of fabrics of a gum:

• At an early stage, necrosis may not manifest itself, but it is during the development of the disease that the loss of pigmentation and luster of the enamel of the teeth is observed, they become sensitive to sharp temperature changes, and the gum bleeds. In addition, the surface of the teeth becomes rough, the gums degenerate and slightly lag behind the teeth.
• With an average degree of severity, there is edematous papillae and the destruction of the tissues of their apexes. The gingival papillae bleed, are covered with a dirty-gray coating and are painful when trying to palpate. Part of the affected gingival is discolored or black, there are sores and an unpleasant odor from the mouth. Desnevoy necrosis causes an increase in regional submandibular and other lymph nodes.
• The middle stage of necrosis is characterized by bright hyperemia and swelling of the marginal gum and gingival papillae. The mucous membrane of the gum is hyperemic and covered with ulcers, and on ulcers a dirty gray coating. On the affected areas, a soft plaque may appear. The body temperature rises to 38-39 ° C, the patient suffers from constant headaches and disturbances of appetite.
• At the last stage of gingival necrosis, there is expressive hyperemia, inflammation and puffiness of its alveolar part, gingival papillae and marginal gingiva. The tissues die, exposing the bone, causing an unpleasant odor from the mouth and painful sensations. On the affected areas there are significant deposits of soft plaque. The patient suffers from high fever, dyspeptic disorders and general ailments.

Diagnosis of gingival necrosis

Diagnosis of gingival necrosis is performed by the dentist, as with routine examination, and when the patient complains of soreness, flushing and bleeding gums. The main diagnostic criteria for necrosis is putrid odor from the mouth, inflammation and swelling of the gums, loss of appetite and sleep disorders, dyspeptic disorders, pain when swallowing, general malaises. Diagnostics uses ray methods, for example, X-ray examination and instrumental examination of the oral cavity, consider the main:

• With the help of an X-ray, it is possible to detect necrotic destruction of the tooth tissue and possible complications from gingival necrosis. This method allows you to determine the degree of tissue destruction, that is, the stage of necrosis.
• In some cases, laboratory studies are carried out, for example, microscopic examination of soft plaque. This makes it possible to determine the composition of microflora, the presence of fungi, the number of leukocytes, spindle-shaped rods and Spiroschet Vincent.

Identification of gingival necrosis depends on the stage of the disease, as in its development pathology goes through several stages. It is on the symptoms of the disease that the dentist draws attention with an instrumental and visual examination of the oral cavity. At the stage of prenecrosis, certain changes in gingival tissue are reversible, but differentiated methods are used for diagnosis. This is necessary to recognize possible dental diseases that have caused problems with the gums.

If there is tissue loss, that is, necrosis of affected cells, then this is a clear sign of necrosis. But in this case, the dentist checks the patient for the presence of concomitant diseases of the oral cavity. With destructive changes, that is, loss of the affected tissues, the doctor conducts studies for the presence of concomitant complications.

[14], [15], [16], [17]

Treatment of gingival necrosis

Treatment of gingival necrosis completely depends on the form of pathology, the stage of its development, the presence or absence of concomitant diseases. As a rule, the treatment of affected tissues is impossible, since necrosis is an irreversible process. Therefore, with this disease, treatment is aimed at restoring blood circulation in the affected areas and eliminating the process of cell necrosis. Dead tissues are removed surgically to eliminate the further spread of the infection.

There are two methods of treatment, that is, removal of necrosis. Therapy can take place both in a hospital setting and under strict medical supervision. There are two forms of necrosis: dry and wet, consider them in more detail:

• Coagulation (dry) necrosis - is a gradual drying of dead tissue and a decrease in their volume (mummification). In this case, the inflammatory reaction occurs extremely rarely, this also applies to infectious damage, there are no signs of intoxication.
• Colliquated (wet) necrosis - accompanied by swelling, inflammatory reaction, an increase in the body or tissues in a size expressed by hyperemia. There are no clear boundaries of affected and healthy tissues, inflammation and swelling extend beyond the tissues affected by necrosis. This form is characterized by putrefactive and purulent infection. Heavy intoxication of the body, headaches and other pathological symptoms develop.

With dry necrosis, the pathology is neutralized by treating the affected tissues with antiseptics. If the tissues are completely dead, they are surgically removed, in the remaining cases, normal blood circulation is restored. To treat wet necrosis, it must be transferred to the dry stage. After that, the tissues are treated with a solution of hydrogen peroxide, they unclose purulent and ulcerated areas and drain them.

If such treatment is unsuccessful, then necrotic tissues are removed urgently. The waiting period for the results of local treatment of wet necrosis is 2-3 days, after which the patient is waiting for the operation. If you do not perform a surgical removal of the affected gingival tissue, then this will lead to serious complications. In addition to the above procedures, the patient is prescribed antibacterial, vascular and detoxification therapy. This is due to the fact that necrosis promotes rapid infectious infection, which entails intoxication of the whole organism.

Prevention of gingival necrosis

Prevention of gingival necrosis is aimed at maintaining the health of the mouth cavity and preventing the appearance of dental diseases. We present the main preventive measures:

• Regular oral care will prevent the multiplication of harmful microorganisms. Obligatory is the removal of stones and plaque.
• In case of malocclusion, it is necessary to consult a dentist to eliminate this pathology. In some cases, a short frenum near the lips or tongue can cause necrosis.
• Food should consist of healthy food, and the diet should be balanced. This is necessary for saturation of the body with vitamins, minerals, micro and macro elements, amino acids.
• Refuse alcohol and tobacco. Such harmful habits adversely affect the health of gums and teeth.
• Reduced protective properties of the immune system can lead to the development of periodontitis, gingivitis or periodontitis. Without proper treatment, these diseases provoke necrosis of the gum.
• If you suffer from chronic diseases of the digestive tract or diabetes, these pathologies are one of the factors in the development of diseases of the oral cavity.

If you have already suffered a necrosis of the gum, you must do everything to prevent the disease from showing itself again. Regularly pass dental examinations, use toothbrushes with soft or very soft bristles. Adhere to oral hygiene, use curative-prophylactic toothpastes that have anti-inflammatory effect. It is not superfluous to use rinsing agents on a plant base with an antiseptic effect.

Prognosis of gingival necrosis

The prognosis of gingival necrosis completely depends on the results of treatment and on the form of the disease. Of course, with a timely request for medical assistance, the outlook is favorable. With effective therapy, the gums stop bleeding, their normal blood supply, color and density are restored. At palpation there are no painful sensations, there are no tooth deposits and an unpleasant smell from a mouth. In this case, it can be said that necrosis is eliminated.

Necrosis of the gum in the late stages or with ineffective treatment has an unfavorable prognosis. A neglected disease can cause a complete loss of masticatory function, damage to regional lymph nodes and teeth, and this leads to complete destruction of the gums and teeth. The patient expects a long and painful treatment and restoration of the dentogingival canals and long-term immunotherapy.