Ulcerative gingivitis

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

ICD-10 code (K05.12)

What causes ulcerative gingivitis?

Ulcerative gingivitis develops as a result of a sharp increase in microbial accumulation and, correspondingly, an increase in their damaging potential, and a reduction in the mechanisms of general and local protection, against which there is a sharp activation of microflora, especially anaerobic and protozoans (fusobacteria, spirochetes). The reasons for the reduction of protective mechanisms can be different: hypothermia, acute respiratory viral infection, tonsillitis, influenza, other infectious diseases, eating disorders (hypovitaminosis C, etc.), stressful situations, smoking, taking drugs.

One of the circumstances that point to the role of reducing the resistance of the body in the occurrence of such a disease as ulcerative gingivitis is that the peak incidence of ulcerative necrotic gingivitis is mainly in the winter-spring period of the year. Students and military personnel, respectively, for the period of the session and training sessions in the "on alert" mode. However, the main reason is often the unsatisfactory hygienic state of the oral cavity. The appearance of an ulcerative process with a 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 characteristic signs: a sharp spontaneous pain, making it difficult to eat, speech, brushing your teeth; presence of ulcers covered with necrotic plaque on the gums; sharp, bad breath. General symptoms of ulcerative gingivitis are accompanied by an increase in body temperature to 37.5-39 ° C. Weakness, headache, pain in the joints, muscles. In a history of such patients usually indicate bleeding gums for a period of several weeks to several years.

When the external examination is usually characterized by an earthy complexion, pale skin. Submandibular lymph nodes are enlarged and painful, abundant salivation, large accumulations of soft plaque on the teeth. Characterized by putrefactive, fetid smell from the mouth.

The gums are clearly hyperemic, bleeds easily, is covered with a grayish coating, which is easily removed, after which a bleeding wound surface is exposed. As a rule, at the height of the process, patients stop brushing their teeth, eat normally, which sharply increases the course of the disease due to severe intoxication and exhaustion of the body, further suppression of the defense mechanisms

How to recognize ulcerative gingivitis?

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

Clinical parameters of blood in a relatively short-term process in most patients within the norm. With a longer course, ESR increases and the number of white blood cells reaches the upper limit of the norm (8.0-9.0x10 ⁹ / l) or higher. However, this may be associated with a background disease.

Differential diagnostics

To differentiate ulcerative gingivitis is necessary, first of all, with ulcerative gingivitis in blood diseases (leukemia, agranulocytosis, etc.) and mild periodontitis with necrotic gingival changes, AIDS, bismuth and lead gingivitis (in 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 focus 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. Above the generally accepted measures, it is necessary to provide for the removal of necrotic masses, for which it is necessary to use proteolytic enzymes in addition to a purely mechanical method: trypsin, chymotrypsin, lysoamidase, lythin, hygrolitin, nuclease, etc. All procedures should be performed under the cover of antiseptic and antimicrobial agents of a broad spectrum . These drugs include lakalut, dysterin, aseptum, chlorhexidine solution 0.06%, gel with 25% metronidazole and chlorhexidine; sanguinarine, sanguirithrin liniment 1%, solution 0.2%. All manipulations should be carried out only under application, infiltration or conduction anesthesia. Prior to simplifying the acute phenomena of inflammation, the patient is prescribed only rinsing with the above solutions, self-application of antiseptic gels and nasties at home. In addition, in connection with the intense pain reaction it is desirable to prescribe for the application of local anesthetics a tablets of bacterial lysates mixture (imudon), which have an analgesic and antimicrobial effect.

Inside appoint: metronidazole 0.25 g 3 times a day and doxycycline 0.2 g once a day - 8 days, ascorbic acid + rutoside (askorutin) 1 tablet 4 times a day, ebastin (kestin), mebhydroline (diazolin ) or loratadin at night, under a stressful situation - bromodihydro-chlorophenyl-benzodiazepinone (phenazepam), Bekhterev's medicine, 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, the defects of the cheap edge remain different.

How to prevent ulcerative gingivitis?

It is the timely treatment of chronic catarrhal gingivitis, dental caries, compliance with oral hygiene rules, and non-smoking. It is especially important to temper the organism in order to increase resistance to the influence of various infections.