Ulcers on the gums in the child and adult: white, red, purulent, trophic

For delicate and delicate gum tissues, the characteristic quality is a pronounced regenerative capacity. Therefore, the appearance of ulcers on their surface should be regarded as a reaction to a change in the state of the organism and the possible emergence of internal unhappiness. Disturbance of the mucous membrane of the mouth creates a lot of inconvenience, in the first place - it's a painful reaction to getting hot, sour, spicy food, later the pain can be felt even at rest. The appearance of ulcers (aft) in the mouth can be a symptom of a variety of diseases. Over time, small sores can merge and become a solid surface, there may also be a smell, felt by others during conversation and breathing. Therefore, having found out in the mouth a sore, it is necessary to take measures to find out the reasons for its appearance and elimination.

Causes of the ulcers on the gum

Pathological ulcerous changes of the oral mucosa are considered as immediate diseases of the soft tissues of the mouth or localized manifestations of systemic pathologies.

The main dental diseases that cause the appearance of sores on the gums are acute and chronic gingivitis (inflammation of the gums) and stomatitis (periodically aggravated aphthous inflammation of the oral mucosa).

Acute (catarrhal) inflammation occurs as a result of a negligent attitude towards hygiene and care for teeth and oral cavity, resulting in a plaque and tooth decay. When untimely treatment develops aphthous stomatitis, which is the next stage of catarrhal and characterized by a more severe course. Against the background of systemic chronic diseases, stomatitis can go on into a chronic form.

There are the following types of chronic diseases: recurrent aphthous, herpetiform, Settona aphthae (recurrent necrotic periadenitis), Bednar aphthae. The latter occur only in infants and in early childhood, are considered a consequence of poor hygienic state of the oral cavity and injuries obtained by careless rubbing of the mucosa. Have nothing to do with chronic stomatitis in adults.

People with granulomatous enteritis and ulcerative colitis infected with HIV and the herpes virus are prone to ulcerative lesions of the gum, during the period of changes in the hormonal background, tumors of the cervical or nasopharyngeal localization.

Hereditary predisposition to aphthous formations was also established.

The appearance of an ulcer on the gums may be due to trauma during treatment at the dentist (especially if the patient is restless), other injuries - acute solid food, stiff bristles of the toothbrush, bite. Injured gums may be sharp crowns, substandard prosthesis, orthopedic plates, aggressive liquids, medicines. Gum injuries are the gateway to infection: viral - it can be caused by simple herpes, adenovirus and even the influenza virus; bacterial - staphylococcal, streptococcal, gonococcal; fungal - candidiasis of the oral cavity.

An ulcer on the gums may appear as an allergic reaction. The cause of such a defect may be poisoning with mercury.

Ulceration of the oral mucosa may be manifestations of systemic infections - syphilis, tuberculosis, fusospirochetosis (ulcerative necrotic gingivostomatitis Vincent), acquired immunodeficiency syndrome. The cause of infection in these cases is non-compliance with certain safety rules for sexual contact and sanitary and hygienic standards in everyday life, poor oral hygiene. For example, Vincent's boreals belong to conditionally pathogenic microbes and in an insignificant number are available to all members of the human race having teeth in the mouth. Direct contact with a patient with an active form of tuberculosis can also lead to infection.

In addition, sores in the mouth can accompany diabetes mellitus and other endocrine diseases, hematopoietic disorders, severe acute and chronic chronic gastrointestinal diseases, neoplasms, renal dysfunction. These diseases, which take place in a severe or long-term course without proper treatment, cause hypovitaminosis. An unbalanced diet, a preference for any one type of food, neglect of plant food leads to vitamin deficiency. Hypovitaminosis C, A, lack of B vitamins, iron, selenium and zinc lead to dry skin and mucous membranes, including in the mouth. They inflame, there are cracks - an excellent gate for infection. The use of a large amount of sweet or sour can also contribute to the appearance of painful sores.

[1], [2]

Risk factors

Risk factors for ulcers caused by any of the listed causes:

• presence of caries teeth and tartar;
• allergy;
• smoking, drinking;
• chemotherapy;
• long-term drug therapy;
• decreased immunity, including after a previous flu or ARVI, stress, physical overexertion;
• inflammation of the gums with teething, not only dairy, but also root, often - wisdom teeth;
• fluctuations of the hormonal background.

Toothpaste or mouthwash with sodium dodecyl sulfate provokes the appearance of stomatitis and increases the frequency of its relapses.

Hypovitaminosis as itself can cause ulcers on the gum, and in combination with other causes increases the likelihood of their appearance. The same can be attributed to injuries to the mucous gums and poor hygiene. Aphids can also arise from the dehydration of the body. Each of the above reasons and their combination can provoke ulcerative gingivitis.

The pathogenesis of the development of this pathology has not yet been fully identified, but, most likely, it is associated with the response of the immune system to stimuli. Presumably, the inflammatory process and sores appear as a reaction of immunity to molecules that are not recognized by them. Their occurrence stimulates lymphocytes to attack strangers (approximately the same reaction is observed in organ transplantation).

Infectious agents that enter the oral mucosa are also attacked. Each infectious disease has its own peculiarities and includes specific pathogenetic links.

Statistics state that stomatitis is the most common inflammatory pathology of the oral cavity. Every fifth inhabitant of the planet has stomatitis. The most susceptible to this disease are children under the age of 4, people of advanced age and pregnant women. Among HIV-infected mouth ulcers are observed in every third patient.

The high incidence in the children's age group is due not to the end formed by the immune system and high contagiousness, people of advanced age in most cases have dentures. The period of pregnancy is characterized by a weakening of the immune status and fluctuations in the hormonal background.

Herpetiform stomatitis is most common among adolescent girls and young women under the age of 30, and fusospirochetny - on the contrary, more often affects men of the same age.

[3], [4]

Symptoms of the ulcers on the gum

So, sores in the mouth can signal the presence of various pathologies. Symptoms are similar, but there are some differences. Consider them.

The formation of aphtha (ulcers on the gums) often occurs with complication of catarrhal (simple) gingivitis, the usual classic ulcer in this case is as follows:

• has a rounded shape;
• small depth;
• the center is tightened with a whitish film, sometimes with a grayish tinge;
• the edges are even, they are surrounded by a red border, the gingival tissue has the usual form;
• As a rule, these formations are characterized by sharp pain, which prevents them from chewing and talking.

As a rule, gingivitis can pass itself in just four days, but sometimes lasts two weeks. It is likely the recurrence of the disease with a frequency of three to four exacerbations per year (a typical picture), some relapses follow one after another, others - less than one per year.

The classical version of the flow is a single aphtha, however, there may be multiple lesions scattered throughout the oral cavity. Close-lying ulcers can merge into one - a large size with irregular outlines.

The depth of ulcers is usually small, although forms of the disease with deep aphthae occur, after healing of which scars may remain.

Types of stomatitis on the gums (gingivitis) are distinguished by the infectious agents that caused them:

• Candidiasis - more often affects children, since the pediatric saliva does not yet contain enough acid to prevent the development of the fungus; susceptible to this disease and elderly patients with prostheses; Candidiasis of the oral cavity occurs often after antibiotic therapy; with this kind of gums covered with white coating, under which there is a hyperemic ulcerated and painful surface;
• viral - contagious, transmitted as through toys, nipples, dishes, and airborne from the carrier or patient; children are more prone to infection; for this species is characterized by red ulcers on the gums, which appear when infected with the herpes simplex virus, they are painful and similar to bleeding at any touch of the wound;
• bacterial - occurs usually when infection is injured on the gum, for example, an ulcer on the gum after tooth extraction; as a causative agent of infection, as a rule, staphylococci and streptococci; as a variant of the complication, a purulent ulcer on the gum may occur;
• allergic - a local reaction to irritation of the oral mucosa by the allergen that has got there.

Acute inflammation caused by trauma, thermal or chemical burn, allergy manifests itself by the formation of a small painful aphthae (ulcers) at the point of contact with a sharp object or irritant. As a rule, these ulcers heal even without treatment for several days. To traumatic and ulcers on the gum from the prosthesis, they are located side by side, can be under the construction or in contact with the prosthesis. The sooner the constructive defect is eliminated, the easier the consequences. If the patient patiently waits, while everything is rubbed, you can complicate the situation, and then without long-term treatment can not do.

The first signs of catarrhal inflammation are sore pain, irritated hyperemic and edematous gums, a yellowish whitish coating in the tongue, the appearance of an unpleasant odor from the mouth. Sometimes the gum can bleed, for example, when brushing your teeth. If you do not take measures to eliminate the catarrhal form, on the mucous membrane of the gum appear aphy - multiple rounded defects with a diameter of about 3 to 5 mm, framed by a rich red border with a yellowish-gray coating. The aft stage of the disease proceeds more severely, the ulcers ache while eating, brushing teeth, the odor becomes putrid, the temperature may rise 37.5-38 ℃, the bovine and submandibular lymph nodes may increase, signs of general intoxication appear - weakness and headache.

Chronic recurrent stomatitis or other forms of aphthous pathologies, their exacerbation arising from time to time for no apparent reason (trauma, stress, prosthesis and the like), can signal the presence of a systemic disease, so it is worth carefully examining. Endocrinological disorders, intestinal diseases, hematopoietic organs, neoplasms can be detected - a failure in the work of any system of the body can make itself known by the appearance of ulcerative defects in the oral cavity.

Periodic occurrence on the gums of small painful aphtochkas (ulcers), which most often disappear after about 6-7 days, may be a symptom of chronic recurrent aphthous stomatitis. With constant trauma or against a background of reduced immunity, prolonged stress, they can spread throughout the mouth, the inner epithelium of the cheeks, appear on the lips, merge into one continuous ulcerative lesion. The treatment will be delayed, the scars may remain on the surface after healing.

Herpetiform stomatitis, which is visible by name, resembles herpes in appearance, although it is not (a rare form of aphthous stomatitis). This multiple small painful aphtochis without clear outlines with a grayish-whitish base, can merge, forming one big lesion. Places of rashes, mainly - the gums, the lower surface of the tongue and the hyoid area. Usually they go through the week, at the most within ten days.

Setton's afts are small ulcers with raised dense margins appearing on the inside of the lips, cheeks and the sides of the tongue facing them. This is how the recurrent necrotic periadenitis manifests (complication of inflammation of the submaxillary lymph nodes). Above on the gum, these aphthae usually do not spread, but below may well be located. Aphthae are painful, the patient is difficult to eat, sometimes he can not talk. Characteristic long-term up to several months.

Fusospirochetosis (ulcerative-necrotic gingivostomat Vincent) usually begins on the gums at the place of permanent trauma (crown), near the destroyed tooth or its absence. Not healed, it gradually grabs the entire gum. Characterized by hyperemic swollen gums, loose and bleeding. Necrotic process begins with the tips of the papillae between the teeth, gradually grabbing the entire gum. It is accompanied by intense pain. There is a necrotic plaque, hypersalivation, the smell of rot from the mouth, high temperatures can rise.

The edges of the ulcer in the acute course of the disease have soft uneven outlines, they cover a copious layer of necrotic greenish-gray plaque with a pronounced putrefactive odor. Removing it with a tampon, you can find a loose, heavily bleeding bottom of the ulcer, surrounded by swollen inflamed tissues.

The clinical course of the disease can take place in mild, moderate and severe forms. With a mild (local lesion of the gum) - the patient's condition is practically not broken, local discomfort is felt during chewing, hot drink. The easiest way to stop the process at this stage. In the middle - the course is aggravated, the sore becomes larger, the severe is usually accompanied by high fever and other intoxication phenomena. The patient can refuse food and hardly talk.

Avitaminosis aphthae can cause hypovitaminosis C - white ulcer on the gums itches and does not heal until the body receives the required amount of vitamin with food or vitamin preparation. In addition to the formation of sores on inflamed gums, the deficiency of this vitamin is accompanied by general weakness and numbness of the extremities, the whole mouth cavity becomes inflamed and ulcerated gradually.

Deficiency of vitamin B2, except ulcers on the gums and tongue, is manifested by dry cracked lips, seizures, insomnia, lacrimation, nausea and vomiting.

Deficiency of vitamin B6 in addition to sores - dry lips, dandruff, numbness of the limbs.

White ulcers of irregular shape on the inner surface of the gums, tongue and cheeks can signal an erosive leukoplakia.

Ulcers on the gums appear and with common infectious diseases. Syphilitic ulcers appear at the site of the pathogen in the first stage of the disease, which occurs after the latent. They are painless, have the appearance of a crater with a glossy-red bottom, sometimes there may be a raid. Scarring occurs within a period of three weeks to three months. Then there are signs of secondary syphilis, rashes and ulceration may also appear in the oral cavity, and also become complicated with fusospirochetosis.

Tuberculosis - are the result of infection with mycobacterium tuberculosis (with lung lesions) of the oral mucosa in places of violation of its integrity, including on the gum. At the site of the introduction, a painful, rapidly growing tubercle appears, the loose base of which usually bleeds.

Gum tissues have good repair properties and usually heal very quickly. Long-lasting non-healing ulcers on the gums can talk about their permanent trauma, serious diseases: the syndrome of acquired immunodeficiency, malignancy, and also that the cause of their occurrence is not determined correctly, the treatment was only symptomatic and additional diagnostics are required.

Ulcer on the gums in the child

There are such lesions for various reasons, any of the factors described above can provoke the appearance of sores on the gum. Poor hygienic condition of the mouth at an early age provokes the emergence of Bednar's aft - erosive formations with a yellowish-whitish film from above. These sores appear also due to injuring the gums with something hard or hard (toy, teeth).

The most common causes of sores in the mouth in a child are viral, candidal, traumatic or allergic acute aphthous stomatitis. The virus often develops on the background of acute respiratory infections, as well as childhood infections (chickenpox, rubella, measles). Symptomatic acute: weakness, capriciousness, hypothermia, lack of appetite, an increase in the submaxillary lymph nodes. The temperature peak coincides with hyperemia and edema of the gums, on which bubble eruptions appear, followed by superficial erosive wounds. Severe pain, hypersalivation accompanies this process. Lips dry out, they appear cracks and crusts, which give the child considerable discomfort.

Aphthous stomatitis manifests itself by the periodic appearance of an ulcer on the gums in a child, the gum bleeding on this site can bleed, swells. The child loses his appetite, becomes irritable, quickly becomes tired. Children, unlike adults, usually have one or two aphtochki, no more.

Allergic reactions usually manifest as a catarrhal form of stomatitis, sometimes with a hemorrhagic component. The gums are itchy, sore, dry. In 2/3 children, lesions from the gums extend to the entire oral mucosa - it swells, spot bleeding occurs, the surface of the tongue becomes inflamed and smooth, and taste sensations are lost. Along with this, the general condition of the child is not violated.

Children can develop acute ulcerative gingivitis. This disease is generally characteristic of young people. At the child it is an extension of the catarrhal form. Symptoms of this disease are necrosis and multiple sores. This condition develops with a decrease in the body's defenses in response to the irritation of the gum tissue by opportunistic pathogens Fusobacterium necroforum and Treponema vincentii. Ulcerative inflammation of the gums is usually regarded as a serious disorder of the child's immune system and indicates a high probability of having common diseases. This pathology is often preceded by teething in the child, acute respiratory infection, stress and other factors contributing to a decrease in immunity. Before the appearance of ulcerative lesions, there are always catarrhal phenomena. The first signs of the development of the inflammatory process - soreness of the gums and their itching, redness, swelling. Appear stagnant phenomena - the interdental papillae acquire a bluish tinge, their bleeding is observed. The first sores are located exactly there, the gingival areas are necrotic and covered with a dirty gray or greenish, easily removable tampon, bloom. The surface of the teeth is also generously covered with a soft, poorly cleaned plaque. There is a plaque in the tongue and sticky saliva. Even in areas of the oral cavity that are not affected by the inflammatory process, there is fibrinous plaque. The child's breathing is unclean and putrid.

The course of the disease is prolonged, accompanied by intoxication. It hurts the child to chew, it does not eat well, loses weight, it is a lot of naughty, becomes irritable. His sleep is disturbed. In the absence of a previous anemic infectious disease or traumatism in the anamnesis of a child due to improper growth of teeth and bite, there is an assumption that he has blood diseases, malignant reticulosis (if the child is not older than 10years old). Older children may have an independent disease - fusospirochete gingivostomatitis.

Complications and consequences

The frivolous attitude towards the appearance of the sore on the gum and the absence of treatment can lead to a more severe form of the disease with a high temperature and symptoms of general intoxication. Aphids can spread throughout the surface of the oral cavity, become deep and reach the muscular or even tendon layer, bone tissue. When the depth of the aphthae reaches the jawbone, osteomyelitis may develop on this site.

With the bloodstream, the infection can spread throughout the body, causing inflammation in distant organs, sepsis.

Continuously relapsing catarrhal gingivitis can be transformed into hypertrophic fibrotic, requiring surgical intervention.

Fusospirochetny gingivostomatitis can spread to the sky and tonsils (angina Simanovsky-Plaut-Vincent). If untimely treatment for help can be irreversible complications: osteolysis of bone tissue, gingival sagging, severe forms of periodontal inflammation, scars in places of deep and extensive ulcerative lesions.

Even if the sores have gone untreated, this does not mean that the infection has disappeared. Most likely the process has passed into a chronic form and from time to time will bother its "master." Such a transition is most likely in the absence of sanation of the oral cavity or in the case of a common chronic disease.

In the end, recurrence of stomatitis on the gums may indicate the presence of chronic pathologies, sometimes very serious, in which the effectiveness of treatment and its prognosis directly depends on the time of detection of the disease.

Leukoplakia is considered a precancerous condition, the risk of malignancy is very high. Its signs are densification at the base of the sore, its bleeding, rapid growth and growth of "papillae" on the surface of the sore. However, such signs appear later, at the initial stages, when it is best to start treatment, they are not yet available. Therefore, when an ulcer appears on the gum, it is advisable to show it to the doctor and take all measures to prevent complications.

[5], [6], [7], [8], [9], [10], [11]

Diagnostics of the ulcers on the gum

Finding a single or multiple sores in the mouth should be addressed, first of all, to the dentist. After examination and questioning of the patient, tests can be assigned - a clinical blood test, special tests - to determine the level of serum iron, vitamin B group. Bacteriological blood culture and microscopy of the oral mucosa, HIV test, Wasserman reaction can be assigned. If there is a possibility of mercury intoxication, an analysis is made for the content of mercury in the urine.

If suspected of having systemic diseases, the patient will need consultation of specialists - gastroenterologist, dermatovenereologist, endocrinologist, phthisiatrist or others depending on the expected pathology. Probably instrumental diagnostics (ultrasound, tomography, radiography) will be appointed.

[12], [13], [14], [15], [16]

Differential diagnosis

According to the survey data, differential diagnostics will be carried out to exclude pathologies that have similar symptoms and reveal the disease to be treated. Exclude infection with the human immunodeficiency virus, syphilis, blood diseases that lead to the appearance of ulcers in the oral cavity, cancer of the oral mucosa, differentiate the ulcerative-necrotic stomatitis of Vincent from stomatitis caused by other pathogens.

[17], [18], [19], [20], [21]

Treatment of the ulcers on the gum

Conservative therapy of ulcerative lesions of gums is carried out in several directions: destruction of infection, alleviation of the patient's condition and strengthening of his immunity. Treatment of ulcers on the gums resulting from such serious infections as syphilis, tuberculosis, HIV is carried out in a hospital under the supervision of specialists.

With gingivitis, mainly local preparations are prescribed. It should be noted that the effective effect of the drug will only after cleaning the dental deposits in the dentist. After this procedure, appropriate treatment will be prescribed.

Antibacterial effect has gel  Metrogil Denta  - complex (metronidazole + chlorhexidine) treatment for oral cavity, it has insufficiently high concentration (below the therapeutic) antibacterial component, however, in some cases it is enough. Effects on the proinflammatory mediators gel does not have, as well as local anesthesia.

A more effective antibacterial agent is  Holisal-gel  - a combination of choline salicylate (anti-inflammatory, antiseptic, analgesic action) and cetalkonium chloride (bactericidal and fungicidal). Acts instantly, inhibits the action of cyclooxygenase, a catalyst for the synthesis of inflammatory mediators. The gel can be applied to the gum for two to three times a day - before eating, to stop pain, and after eating - to kill germs and relieve inflammation. This drug is approved for use with a one-year-old age, possibly its use by pregnant and lactating women.

Gum treatment is performed twice a day after meals and hygiene procedures. First carefully brush your teeth with a soft brush, trying not to injure the sores, then you should rinse your mouth with Chlorhexidine and get wet gums with gauze or a cotton pad. The gel is applied with a clean finger not only on the front part of the gum, but also on the inside. After that, you can not drink about half an hour and eat for two or three hours. Saliva does not spit, but is swallowed, as usual.

With inflammation caused by viruses, antibacterial gels are absolutely useless. The doctor can prescribe  Bonaflon Ointment (0.5%), which is effective when infected with herpes simplex virus. It blocks the processes of its development and growth. It is applied to the affected surface twice or thrice a day.

It is active against the herpes simplex virus, as well as adenovirus and influenza virus  Tebrofen ointment. It is produced in concentrations of 0.25 and 0.5%. Depending on the severity of the process, the doctor will prescribe the required concentration and frequency of application (three to four times a day).

Herpetic stomatitis is usually accompanied by severe pain, as an anesthetic is recommended  Anestezinovaya ointment  (active ingredient - benzocaine). Surface anesthesia occurs a minute after application. It can be used both for adults and children from the age of two. May cause allergies, not intended for lactating mothers. In the place of application sensitivity may be impaired.

Analgesic properties have  Benzydamine  - mouthwash, which additionally has an additional anti-inflammatory effect.

According to the practice of dentists, most of the stomatitis, especially in children, is an allergic reaction. Children and adults who assume allergy prescribe antiallergic drugs, for example,  Fenkarol  (hifenadine hydrochloride) - blocking H1 receptors and, in addition, stimulating the enzymatic activity of diaminoxidase, which cleaves almost a third of endogenous histamine. It surpasses classical antihistamines by activity, and also by the duration of the action. Characterized by speed and does not cause severe sedation. Contraindicated with individual sensitivity and in the first trimester of pregnancy.

Take orally after eating: adults - three times or four times a day, the daily dose should not exceed 0.2 g.

Children's dosages: less than three years - no more than 15 mg / day in two or three doses; 3-6 years - 20 mg / day in two divided doses; 7-12 years - 30-45mg / day in two or three sessions; over 12 years old - 50-75 mg / day in two or three doses.

Ulcers treated with antiseptics, prescribe local anesthesia.

To remove bacterial plaque that slows healing of the ulcer, use furatsilin, hydrogen peroxide, carbamide peroxide. To accelerate the healing and activation of restoration of the gingival tissue, ointments with a keratoplastic effect (Solcoseryl, Metiluracil) are used.

An obligatory condition for effective treatment of fusospirochetosis is scrupulous treatment of the oral cavity, including the removal of dead tissue and deposits of nad- and subgingival calculus. In the course of treatment, the oral cavity is washed with antiseptic solutions of chlorhexidine, potassium permanganate, hydrogen peroxide and others, with particular attention paid to the edge of the gums and dentogingival pockets. In the clinic appoint daily applications of solutions of proteolytic enzymes, for example,  Trypsin, cleavage of dead tissue and fibrinous clots, diluting viscous products of secretion and exudation, relieves inflammation. At home, the patient can treat the gum with  Maraslavin  (a multicomponent plant antiseptic), which, in addition, anesthetizes, accelerates healing, reduces allergy and inflammation. Also at home, rinsing with a warm antiseptic is recommended.

Broad-spectrum antibiotics are prescribed in severe or complicated cases (with ulcerative necrotic angina), when local procedures do not have a quick effect. Anaerobic bacteria that cause disease, spindle-shaped sticks and borrelias of Vincent, are destroyed with the help of antibacterials of a wide spectrum of action. They are sensitive to Clindamycin or Metronidazole.

According to the indications can be prescribed drugs to maintain cardiac activity, antihistamines,

Patients after Vincent's gingivostomatitis undergo regular medical examination for a year after the cure.

Ulcerative necrotic gingivitis, which developed in the pathologies of the hematopoietic system, scurvy, poisoning with mercury, is treated with systemic therapy.

In the treatment of ulcerative lesions of the gums of any etiology, the patient must be prescribed vitamins: ascorbic acid, thiamin, pyridoxine and other by the choice of a doctor, helping to strengthen the body's defenses.

In the treatment of inflammation of the oral cavity, physiotherapy is widely used. Effective is considered the influence of ultraviolet rays or currents of d'Arsonval on aphthae. Medicinal electrophoresis is used for anesthetizing and relieving inflammation.

With inflammation of the gums, including purulent, electromagnetic fields of ultrahigh and superhigh frequency can be used. Magnetic waves of centimeter range are used.

Ulcerative gingivitis is treated with laser, magnetic and ultrasound therapy.

Physiotherapeutic procedures allow you to achieve a therapeutic effect faster. When they are used, the medication is minimized, thereby reducing the likelihood of side effects. Usually, physiotherapy is well tolerated by patients of any age. Although there are a number of contraindications to the use of these methods of treatment, in particular, neoplasms and blood diseases, metal prostheses in the zone of action. Pregnant women are prohibited from microwave and laser therapy. Do not prescribe physiotherapy during acute illnesses and patients with decompensated chronic pathologies.

Home Treatment

If the defect is single and is not accompanied by systemic symptoms and its origin (traumatic, allergic, consequences of infections, chronic diseases) seems obvious, you can try to get rid of the sore home remedies. But it should be borne in mind that gum tissues have good restorative abilities and, if the fast positive result of the applied efforts is not noticeable, do not pull with the reference to the dentist. Perhaps pathology requires a completely different treatment.

Ulcers that occur when the gums injure the sharp edges of the untreated tooth, poor-quality crown and other similar causes, first of all, require their elimination (refurbishment or treatment of the tooth, elimination of an incorrect bite, defect of the prosthesis).

It is necessary several times a day to rinse the mouth with infusions of medicinal herbs (marigold, sage, chamomile), and in the morning it is desirable to rinse with disinfectant solution, for example, soda or furatsilina. And then during the day after each meal rinse the mouth with infusion of some herbs and grease ulcers with a cotton swab with sea buckthorn oil. You can apply Maraslavin, which is imposed on aftochki and inflamed gums in the form of lotions. Without a prescription, Metrogyl-dent gel, which has a moderate antimicrobial effect, can be bought at any pharmacy, you can use Metiluracil Ointment to speed up healing. To reduce inflammation and disinfection, it is possible to treat the oral cavity with Ingaliptum or Lugol's solution in the form of a spray.

Viral stomatitis can be tried with antiviral ointments, without forgetting to rinse your mouth with antiseptics (infusions of herbs, potassium permanganate solution). Pharmacy preparations should be used according to the instructions to them.

Antiseptic rinse solution can be prepared as follows: dissolve four or five tablets of furacilin in boiling water (0.4-0.5 l), then add a teaspoon of sea salt, stir well when the water temperature drops to 37 ℃, add a teaspoon to the solution soda. Rinse with room temperature or a little warm during the day.

As a disinfectant solution, it is also possible to use manganese. It must be well filtered so that no undissolved grains can enter that can cause a burn of the mucous membrane.

Alternative treatment of ulcerative gingivitis involves the use of both pharmaceuticals and cooked houses. Prescriptions for alternative medicine can be included in medical treatment regimens for treating the oral cavity at home. Only preliminary it is necessary to consult with the attending physician, as not always alternative means are combined with medicinal.

For the treatment of aphthous stomatitis, the following can be used: a crushed tablet of nystatin to grind with the contents of the ampule of vitamin B12 for injection. With this mixture, spread the aphthae and the inflamed part of the gum. The author claims that the beneficial effect of such treatment comes almost immediately and recommends the use of this remedy for the treatment of sores on children's gums.

For rinses, you can use the tincture of calendula. Dilute in the proportion: for ½ cup of water - 25 drops of tincture. Hydrogen peroxide for rinsing is taken in the amount of a teaspoon per ½ cup of water.

Afts can simply be lubricated with honey if there is no allergy to this product. Honey can be used several times a day, it can also be used to treat young children.

You can lubricate the gums with honey, mixed with mashed almond nuts. The remedy is effective even with herpetic stomatitis.

Aphthous stomatitis can be cured quite simply, regularly rinsing the mouth with hot water. For mouthwashes, freshly squeezed carrot juice is used, diluted with water, decoctions of oak bark or walnut leaves.

It is possible to get rid of the sore on the gum with the help of herbal treatment. For example, rinse your mouth with infusion after eating at least twice a day:

• from the root of the cotton napkin - brew 20g of grass ¼ liter of boiling water, after two hours strain;
• from the grass of elecampane - will brew 50g of grass ½ liter of boiling water, strain in half an hour;
• from the herb of thyme - brew a tablespoon of vegetable raw materials ¼ liter of boiling water, strain in half an hour.

Decoction of marigolds (marigolds) is also used for rinses, for which a tablespoon of dried flowers are brewed ¼ liter of boiling water and boiled on low heat for another ten minutes, filter and rinse the mouth.

You can take a medicine from a freshly cut yarrow. The entire aerial part of the plant is used. Grind it and squeeze out the juice, mix it with honey to taste. The course of treatment - three weeks, daily dose - three teaspoons.

However, do not forget that treatment with alternative means can help only in cases where ulcerative lesions of the gums are caused by completely harmless causes. If the sores appear regularly, this may indicate the presence of serious general pathologies. In this case it is necessary to be carefully examined.

Homeopathy

Homeopathic treatment, based on the activation of the body's own defenses, is safe (almost without side effects) and very effective, excellently copes with the formation of ulcers on the gums, even caused by systemic chronic pathologies. Self-medication in this case is unacceptable, consultation of a doctor of appropriate qualification is needed, since effective treatment is possible only with the correct appointment of an individual homeopathic preparation. Very good at homeopathic treatment of children.

In the treatment of ulcerative gingivitis, both constitutional remedies and those prescribed for symptomatology are used. Often, Nux vomica, Lycopodium, Sulfur, Lachesis, Tuya, Mercurius solubilis, Mercurius solubilis (mercury solubilis mercury) and other drugs are used. . For example, Mercurius solubilis and Hepar Sulfur may be prescribed in the case of purulent ulcers, however, other properties of the drug are taken into account when prescribing. Its effect is influenced by homeopathic breeding. So, high dilutions of Hepar Sulfur stop the formation of pus and act resorptively, and low - can contribute to suppuration. The same drug can be used for problems with teething wisdom. When allergic ulcers are prescribed Apis (Apis - bee venom), usually in medium dilutions.

Vincent's Gingivostomatitis can be successfully cured by Belladonna, Phytolacca (American Phytolacca), Capsicum (Capsicum - vegetable pepper).

With aphthous stomatitis, the doctor can recommend Mercurius solubilis (Mercurius solubilis - mercury), Borax (Borax), Calendula officinalis (Calendula), Nitricum acidum (Acidum nitricum - nitric acid).

Individually prescribed medication can bring a quick enough relief from pain, inflammation and other discomfort, and also help to eliminate the underlying disease. But, it should be noted that in spite of small doses and the absence of side effects, homeopathic preparations should not be taken alone. Wrongly appointed, they can cause a number of painful symptoms.

Pharmacy homeopathic preparations can be prescribed by the dentist, as a component of a therapeutic regimen or a mono drug. The drug for the treatment of inflammation in the oral cavity is Nux vomica-Homaccord. It consists of four independent homeopathic remedies, each of them in several dilutions. The action of its components determines the overall therapeutic effect of the drug:

Nux vomica (Nux vomica or nausea, vomiting) cures inflammatory processes throughout the entire esophageal tract from the oral cavity (gingivitis and stomatitis) to the colon and rectum of microbial and neurological etiology, and also due to excessive consumption of alcoholic beverages and tobacco products

Bryonia (Brionia or white perestupen) - has analgesic abilities, has an effect on the mucous membranes.

Licopodium (Lycopodium or mace-shaped buzzard) is an anti-inflammatory and analgesic effect, including on the oral mucosa.

Colocynthis (Colocynthis) - antispasmodic, removes inflammation and intoxication.

Sensitization reactions to the ingredients of the preparation are possible. Drops are taken a quarter of an hour before meals or an hour later, spreading them in half a glass of water and drinking three times during the day at regular intervals, without immediately swallowing and holding some time in the mouth. Dosage: children 0-1 year - a day for nine drops, 2-6 years - 15 drops, patients over 6 years - 30 drops. You can dilute in a teaspoon a single dose of the drug: children 0-1 year - three drops, 2-6 years - 5 drops, patients older than 6 years - 10 drops and take sublingually three times a day.

For the purification of the body, the removal of intoxication and inflammation are taken in conjunction with complex homeopathic preparations Renel (in addition, enhances the analgesic effect) or Lymphomyosot (improves the outflow of lymph, enhances the immune stimulating effect).

Surgery

Basically ulcerative lesions of the gum are treated with conservative methods, however, with complications such as fibrotic hypertrophic gingivitis, such treatment is often ineffective. Then they resort to surgery. Expanded interdental papillae of the gums are removed with liquid nitrogen (cryodestruction). The method of diathermocoagulation is also used - cauterization of hypertrophied tissue with the help of alternating current of high frequency.

Practically there is excision of hypertrophied interdental papilla with the help of a surgical scalpel (gingivectomy).

If erosive leukoplakia is diagnosed, excision of the foci is also recommended, followed by a histology of samples of the removed tissues for the purpose of earlier detection of the malignant process.

Malignant neoplasms, manifested as an ulcer on the gum, are subject to surgical treatment.

Prevention

The risk of ulcers on the gums is significantly reduced in people who lead a healthy lifestyle - not smoking, not drinking and eating properly.

An important place among preventive measures is occupied by hygiene of the oral cavity, regular visits to a dentist and timely treatment of dental pathologies. It is necessary to try to avoid injuring the mucous membrane of the gum.

Vitamin therapy is also important, especially in the period of infectious diseases and with prolonged drug therapy. Strengthening of immunity is the key to the absence of recurrences of ulceration of the gum.

[22], [23], [24]

Forecast

Since the appearance of an ulcer on the gum may be caused by different causes, the prognosis is completely dependent on the etiology of the defect. In most cases, the sores are removable and the gum tissue quickly and safely heals.

In general, with light and medium degrees of gingivitis, overall well-being does not change significantly and the capacity for work, usually, is also not lost. With timely measures taken - sanitation of the oral cavity, correction of defects in the prosthesis and others, the improvement occurs already within the first day and within a few days epithelialization of ulcers occurs. In the case of more severe forms of the disease, treatment can be delayed for months, however, the forecast is mostly favorable.