Swelling gingivitis

When gum tissues are affected by infection, their inflammation develops with the formation of swelling - edematous gingivitis or edematous form of hypertrophic gingivitis, in which there is an excessive increase in the soft tissues of the gingiva - the epithelium of the neck of the teeth and the mucosa of interdental papillae. [1]

Epidemiology

Among all periodontal diseases, gingivitis is considered the most common; according to foreign dentists, some degree of gingival inflammation is present in almost 70% of adults, but the exact number of cases of swollen gingivitis is unknown.

Many experts separately this form of gingivitis do not distinguish, because bleeding gums and the presence of their swelling (swelling) are clinical signs of this disease.

Causes of the edematous gingivitis

The key cause of gingival inflammation or gingivitis (from Latin gingivis - gums) is bacterial infection, which - in case of poor oral hygiene - leads to the formation of microbial plaque on the teeth (gingivitis). Gingivis) is bacterial infection, which - in case of insufficient oral hygiene - leads to the formation of microbial plaque on the teeth (in the gingival sulcus, along the gum margin and on the surface of the teeth) and, if it accumulates, to the gradual transformation of plaque into tartar.

The development of gingivitis, including its edematous form, is caused by plaque-forming bacteria of the obligate microflora of the oral cavity: Streptococcus mutans, Fusobacterium nucleatum, Actinomyces, Veillonella, Actinobacteria, Capnocytophaga spp, Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia and others.

Risk factors

The main risk factors for developing swelling form of gingivitis include:

• inadequate oral hygiene;
• crowded teeth, bad bite, ill-fitting dentures;
• smoking;
• weakened immune system;
• diabetes.

Pathogenesis

The leading biochemical element in the pathogenesis of gingival edema formation in gingivitis is inflammatory cellular infiltration caused by prolonged cytotoxic effects of infectious agents of bacterial plaque.

At the early stage, when toll-like receptors (TLRs) expressed in epithelial cells bind to bacterial endotoxins (antigens), proinflammatory cytokines (IL-1β, IL-6, etc.) are produced by immune helper T cells (Th), B cells, and macrophages. That is, an immune response to the infection is triggered.

Inflammatory mediators are also stimulated, including histamine, which is released by mast cells and, acting on H1-receptors, increases the permeability of blood vessels due to their vasodilation - dilation due to relaxation of vascular walls.

This stage is characterized by an acute exudative-inflammatory reaction, increased outflow of gingival fluid from the gingival sulcus, as well as intravascular migration of neutrophils (leukocytes formed in the bone marrow, which provide nonspecific cellular immunity) from the blood vessel of the subgingival plexus, located in the connective tissue of the gingiva, into the gingival sulcus.

Next, neutrophil extravasation or transendothelial migration occurs - their penetration into the wall of a blood vessel. And the cascade of neutrophil migration (or the cascade of their recruitment to inflamed tissues) is completed by interstitial migration with penetration of these protective cells into the gingival mucosa to prevent further tissue damage.

At the same time - under the action of collagenase and other enzymes secreted by neutrophils - collagen destruction and changes in the matrix of the connective tissue of the gingival margin with the accumulation of inflammatory infiltrate occur.

Symptoms of the edematous gingivitis

In the edematous form of hypertrophic gingivitis, the first signs are manifested by swelling (edema) of the gum. There may also be marked redness (due to increased blood flow to the affected area), burning sensation and pressure; there may be painful gums with bleeding when brushing teeth and eating.

Hyperplasia of the gingival mucosa is evidenced by significant thickening of the gingival margin in the form of a roll. [2]

Complications and consequences

In the case of edematous form of gingivitis possible complications and consequences are expressed not only in inflammatory changes in the gingival mucosa, but also in bacterial infection of the supporting tissues of the teeth and surrounding structures - periodontitis, which is often accompanied by loosening of teeth with the threat of their loss. [3]

Diagnostics of the edematous gingivitis

Gingivitis of any type is diagnosed during a oral examination.

General and clinical blood tests may be required, as well as instrumental diagnostics - orthopantomogram. [4]

Differential diagnosis

Differential diagnostics is carried out, as gingival edema is possible, which is not associated with gingivitis, but develops as a result of gingival burn, candidiasis stomatitis or allergic gingivostomatitis. In addition, swelling and hypertrophy of gingival epithelial tissues is observed in acute vitamin C deficiency (and is a symptom of scurvy), in hormonal changes (in pregnant women, in girls during puberty), in orofacial granulomatosis and leukemia, as well as due to prolonged use of a number of drugs (anticonvulsants, hypotensive, antiarrhythmic). [5]

Treatment of the edematous gingivitis

How is swollen gingivitis treated? The main goal of gingivitis treatment is to reduce inflammation, which is achieved by using antiseptic mouthwashes containing chlorhexidine combined with mechanical removal of plaque and tartar.

Also read:

• Treatment of gum inflammation
• Gum diseases and their treatment
• Ointments and gels for gum inflammation

At home, dentists recommend rinsing the mouth with salt water, a solution with hydrogen peroxide (mix three tablespoons of 3% hydrogen peroxide with the same amount of boiled water), a solution with essential oil of peppermint, tea tree or thyme (three drops per glass of water), a solution with the addition of liquid extract of aloe vera, decoction of chamomile pharmacy or cooled green tea.

Prevention

The swollen form of gum inflammation is reversible and can be prevented by practicing good oral hygiene.

Forecast

In the treatment of edematous gingivitis, the prognosis of its outcome is positive. The main thing is to prevent its progression to periodontitis.

List of authoritative books and studies related to the study of edematous gingivitis

1. "Carranza's Clinical Periodontology" - by Michael G. Newman, Henry H. Takei, Perry R. Klokkevold (Year: 2019)
2. "Clinical Periodontology and Implant Dentistry" - by Niklaus P. Lang (Year: 2015)
3. "Gingival Diseases: Their Aetiology, Prevention and Treatment" - by Samuel S. Kramer (Year: 1960)
4. "Periodontology for the Dental Hygienist" - by Dorothy A. Perry, Phyllis L. Beemsterboer (Year: 2019)
5. "Clinical Periodontics" - by Michael S. Block (Year: 2017)
6. "Understanding Periodontal Diseases: Assessment and Diagnostic Procedures in Practice" - by Iain L. C. Chapple (Year: 2003). Chapple (Year: 2003)
7. "Periodontology at a Glance" - by Valerie Clerehugh (Year: 2012)
8. "The Gingival 5′ Untranslated Region: A Novel Regulatory Element in Keratinocyte Proliferation" - by Huseyin Uzuner, Venkata D.Y. Mutyam, Sevki Ciftci (Year: 2020)
9. "Understanding and Managing Gingivitis: A Professional Guide for Dental Hygienists" - by Kathleen Hodges, Carol Jahn (Year: 2004)

Literature

Dmitrieva, L. A. Therapeutic stomatology : national guide / edited by L. A. Dmitrieva, Y. M. Maksimovskiy. - 2nd ed. Moscow : GEOTAR-Media, 2021.