Ulcerative gingivitis

Ulcerative gingivitis is extremely rare as a primary lesion, as a rule, it represents the exacerbation phase of chronic catarrhal gingivitis and is characterized by pronounced alteration phenomena.

Code according to ICD-10 (K05.12)

What causes ulcerative gingivitis?

Ulcerative gingivitis develops as a result of a sharp increase in microbial clusters and, accordingly, an increase in their damaging potential, as well as a decrease in the mechanisms of general and local protection, against which there is a sharp activation of microflora, especially anaerobic and protozoa (fusobacteria, spirochetes). The reasons for the decrease in protection mechanisms can be different: hypothermia, acute respiratory viral infections, tonsillitis, flu, other infectious diseases, nutritional disorders (hypovitaminosis C, etc.), stressful situations, smoking, drug use.

One of the circumstances indicating the role of decreased resistance of the body in the occurrence of such a disease as ulcerative gingivitis is that the peak incidence of ulcerative necrotic gingivitis usually occurs in the winter-spring period of the year. In students and military personnel - respectively, during the session and training sessions in the "alarm" mode. However, the main reason is often the unsatisfactory hygienic condition of the oral cavity. The occurrence of an ulcerative process with difficult eruption of the third molar is also explained by the large accumulation of microorganisms present in such cases.

What are the symptoms of ulcerative gingivitis?

The most typical symptoms are: sharp spontaneous pain that makes it difficult to eat, speak, and brush teeth; the presence of ulcers covered with necrotic plaque on the gums; a sharp, unpleasant odor from the mouth. General symptoms of ulcerative gingivitis are accompanied by an increase in body temperature to 37.5-39 °C, weakness, headache, pain in the joints and muscles. In the anamnesis, such patients usually indicate bleeding gums lasting from several weeks to several years.

On external examination, the following are usually characteristic: an earthy complexion, pale skin. The submandibular lymph nodes are enlarged and painful, there is abundant salivation, large accumulations of soft plaque on the teeth. A putrid, foul odor from the mouth is characteristic.

The gums are brightly hyperemic, bleed easily, covered with a grayish coating, which is easily removed, after which the bleeding wound surface is exposed. As a rule, at the height of the development of the process, patients stop brushing their teeth, eating normally, which sharply aggravates the course of the disease due to severe intoxication and exhaustion of the body, even greater suppression of defense mechanisms

How to recognize ulcerative gingivitis?

The diagnosis of ulcerative gingivitis is not difficult due to the characteristic clinical picture.

Clinical blood parameters in a relatively short-term process are within normal limits in most patients. In a longer course, ESR and the number of leukocytes increase to the upper limit of the norm (8.0-9.0x10 ⁹ /l) or higher. However, this may also be associated with an underlying disease.

Differential diagnostics

It is necessary to differentiate ulcerative gingivitis, first of all, from ulcerative gingivitis in blood diseases (leukemia, agranulocytosis, etc.) and mild periodontitis with necrotic changes in the gums, AIDS, bismuth and lead gingivitis (in the case of ulcerative-necrotic changes in these diseases),

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How is ulcerative gingivitis treated?

Local procedures are similar to those for exacerbation of chronic catarrhal gingivitis. They are aimed at eliminating the source of acute inflammation, preventing the spread of pathological changes to other parts of the oral mucosa. General measures are aimed at increasing the body's resistance and eliminating intoxication. In addition to the generally accepted measures listed, it is necessary to provide for the removal of necrotic masses, for which, in addition to a purely mechanical method, proteolytic enzymes should be used: trypsin, chymotrypsin, lysoamidase, lithin, hygrolithin, nucleases, etc. All procedures should be carried out under the cover of broad-spectrum antiseptic and antimicrobial drugs. Such drugs include lacalut, dysterin, asepta, 0.06% chlorhexidine solution, gel with 25% metronidazole and chlorhexidine; sanguinarine, sanguinarine liniment 1%, solution 0.2%. All manipulations should be carried out only under application, infiltration or conduction anesthesia. Until the acute inflammation is relieved, the patient is prescribed only rinses with the above solutions, independent application of antiseptic gels and nast at home. In addition, due to the intense pain reaction, it is advisable to prescribe for independent applications of local anesthetics tablets of bacterial lysates mixture (imudon), which have an analgesic and antimicrobial effect.

Orally prescribed: metronidazole 0.25 g 3 times a day and doxycycline 0.2 g 1 time per day - 8 days, ascorbic acid + rutoside (ascorutin) 1 tablet 4 times a day, ebastine (kestin), mebhydrolin (diazolin) or loratadine at night, in a stressful situation - bromdihydro-chlorophenyl-benzodiazepinone (phenazepam), Bekhterev's mixture, etc.

After eliminating acute inflammatory phenomena, it is necessary to sanitize the oral cavity and teach the patient the rules of hygiene.

Depending on the degree of ulcerative lesions, after treatment, there remain defects of varying severity on the cheap edge.

How to prevent ulcerative gingivitis?

It consists of timely treatment of chronic catarrhal gingivitis, dental caries, compliance with oral hygiene rules, and quitting smoking. Hardening the body is especially important in order to increase resistance to the effects of various infections.