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

A characteristic quality of thin and delicate gum tissue is a pronounced regenerative capacity. Therefore, the appearance of an ulcer on their surface should be assessed as a reaction to a change in the state of the body and the possible emergence of internal trouble. Violation of the oral mucosa creates a lot of inconvenience, first of all - this is a painful reaction to the ingestion of hot, sour, spicy food, later pain can be felt even at rest. The appearance of ulcers (aphthae) in the mouth can be a symptom of various diseases. Over time, small ulcers can merge and turn into a solid ulcerated surface, and an odor may also appear, felt by others when talking and breathing. Therefore, having discovered an ulcer in the mouth, it is necessary to take measures to find out the reasons for its appearance and elimination.

Causes gingival ulcers

Pathological ulcerative changes in the oral mucosa are considered as direct diseases of the soft tissues of the mouth or manifestations of systemic pathologies localized there.

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

Acute (catarrhal) inflammations occur as a result of careless attitude to hygiene and care of teeth and oral cavity, which results in plaque and tooth decay. If treatment is not timely, aphthous stomatitis develops, which is the next stage of catarrhal and is characterized by a more severe course. Against the background of systemic chronic diseases, stomatitis can become chronic.

The following types of chronic diseases are distinguished: recurrent aphthous, herpetiform, Setton's aphthae (recurrent necrotic periadenitis), Bednar's aphthae. The latter occur only in infants and in early childhood, and are considered to be a consequence of poor oral hygiene and injuries sustained from careless wiping of the mucous membrane. They have nothing in common with chronic stomatitis in adults.

People who are predisposed to the development of ulcerative gum lesions are those suffering from granulomatous enteritis and non-specific ulcerative colitis, those infected with HIV and the herpes virus, during periods of hormonal changes, and those with tumors in the cervical or nasopharyngeal region.

A hereditary predisposition to aphthous formations has also been established.

The appearance of a gum ulcer may be associated with an injury during dental treatment (especially if the patient is restless), other injuries - sharp hard food, hard bristles of a toothbrush, a bite. Gum injuries can be caused by sharp crowns, poor-quality dentures, orthopedic plates, aggressive liquids, and medications. Gum injuries are a gateway for infection: viral - the cause may be simple herpes, adenovirus, and even the flu virus; bacterial - staphylococcal, streptococcal, gonococcal; fungal - oral candidiasis.

An ulcer on the gum may occur as an allergic reaction. Mercury poisoning may be the cause of such a defect.

Ulcers of the oral mucosa may be manifestations of systemic infections - syphilis, tuberculosis, fusospirochetosis (ulcerative necrotic gingivostomatitis of Vincent), acquired immunodeficiency syndrome. The cause of infection in these cases is non-compliance with certain safety rules during sexual contact and sanitary and hygienic standards in everyday life, poor oral hygiene. For example, Borrelia Vincent belongs to opportunistic microbes and is present in small quantities in all representatives of the human race who have teeth in the mouth. Direct contact with a patient with an active form of tuberculosis can also cause infection.

In addition, mouth ulcers may accompany diabetes mellitus and other endocrinological diseases, blood disorders, severe acute and protracted chronic gastrointestinal diseases, neoplasms, and kidney dysfunction. These diseases, severe or long-term without proper treatment, cause hypovitaminosis. An unbalanced diet, preference for one type of food, and neglect of plant foods lead to vitamin deficiency. Hypovitaminosis C, A, lack of B vitamins, iron, selenium, and zinc lead to dry skin and mucous membranes, including those in the mouth. They become inflamed, cracks appear - an excellent gateway for infection. Eating large amounts of sweet or sour foods can also contribute to the appearance of painful ulcers.

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Risk factors

Risk factors for developing ulcers due to any of the following causes:

• the presence of dental caries and tartar;
• allergy;
• smoking, drunkenness;
• chemotherapy;
• long-term drug therapy;
• decreased immunity, including after the flu or acute respiratory viral infection, stress, physical overexertion;
• inflammation of the gums during teething, not only baby teeth, but also permanent teeth, often wisdom teeth;
• fluctuations in hormonal levels.

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

Hypovitaminosis can be the cause of gum ulcers by itself, and in combination with other causes increases the likelihood of their occurrence. The same can be attributed to injuries to the mucous membrane of the gum and its poor hygiene. Aphthae can also occur due to dehydration of the body. Each of the above causes and their combinations can provoke ulcerative gingivitis.

The pathogenesis of this pathology has not yet been fully identified, but it is most likely associated with the immune system's response to irritants. Presumably, the inflammatory process and ulcers appear as an immune response to molecules it does not recognize. Their occurrence stimulates lymphocytes to attack strangers (approximately the same reaction is observed during organ transplantation).

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

Statistics show that stomatitis is the most common inflammatory pathology of the oral cavity. Every fifth inhabitant of the planet suffers from stomatitis. Children under 4 years of age, elderly people and pregnant women are most susceptible to this disease. Among HIV-infected people, mouth ulcers are observed in every third patient.

The high incidence rate in the children's age group is explained by the immune system not being fully formed and high contagiousness; elderly people in most cases have dentures. The period of pregnancy is characterized by a weakening of the immune status and fluctuations in hormonal levels.

Herpetiform stomatitis is most common among teenage girls and young women under 30 years of age, while fusospirochetal stomatitis, on the contrary, more often affects males of the same age.

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Symptoms gingival ulcers

So, mouth ulcers can signal the presence of various pathologies. Their symptoms are similar, but there are some differences. Let's consider them.

The formation of aphthae (ulcers on the gum) most often occurs as a complication of catarrhal (simple) gingivitis; a typical classic ulcer in this case looks like this:

• has a round shape;
• shallow depth;
• the center is covered with a whitish film, sometimes with a grayish tint;
• the edges are smooth, they are surrounded by a red border, further on the gum tissue has a normal appearance;
• As a rule, these formations are characterized by sharp pain that interferes with chewing and speaking.

As a rule, gingivitis can go away on its own in just four days, but sometimes it lasts for two weeks. It is quite possible that the disease will relapse with a frequency of three to four exacerbations per year (typical picture), some have relapses one after another, while others have less than one per year.

The classic course is a single aphtha, but there may also be multiple lesions scattered throughout the oral cavity. Closely located ulcers may merge into one - large in size with irregular outlines.

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

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

• Candidal - most often affects children, since children's saliva does not yet contain enough acid to prevent the development of fungus; elderly patients with dentures are also susceptible to this disease; oral candidiasis often occurs after antibiotic therapy; with this type, the gums are covered with a white coating, under which there is a hyperemic ulcerated and painful surface;
• viral - contagious, transmitted through toys, pacifiers, dishes, as well as by airborne droplets from a carrier or a sick person; children are more susceptible to infection; this type is characterized by red ulcers on the gums that appear when infected with the herpes simplex virus, they are painful and look like wounds that bleed at any touch;
• bacterial - usually occurs when a gum injury becomes infected, for example, a gum ulcer after tooth extraction; the causative agent of the infection is usually staphylococci and streptococci; as a complication, a purulent ulcer on the gum may occur;
• allergic - a local reaction to irritation of the oral mucosa by an allergen that has entered there.

Acute inflammation caused by trauma, thermal or chemical burns, allergies manifests itself in the formation of a small painful aphtha (ulcer) at the site of contact with a sharp object or irritant. As a rule, these ulcers heal even without treatment in a few days. Ulcers on the gum from a denture are also traumatic; they are located nearby, can be under the structure or in contact with the denture. The sooner the structural defect is eliminated, the easier the consequences. If the patient waits patiently until everything is ground in, the situation can be complicated, and then long-term treatment cannot be avoided.

The first signs of catarrhal inflammation are aching pain, irritated hyperemic and swollen gums, yellowish-whitish coating on the tongue, and an unpleasant odor from the mouth. Sometimes the gums may bleed, for example, when brushing teeth. If measures are not taken to eliminate the catarrhal form, aphthae appear on the mucous membrane of the gum - multiple round defects with a diameter of about 3 to 5 mm, framed by a rich red border with a yellowish-gray coating. The aphthous stage of the disease is more severe, ulcers hurt when eating, brushing teeth, the smell becomes putrid, the temperature may rise to 37.5-38 ℃, the parotid and submandibular lymph nodes may increase, signs of general intoxication appear - weakness and headache.

Chronic recurrent stomatitis or other forms of aphthous pathologies, their exacerbations, occurring from time to time without apparent reasons (injuries, stress, dentures, etc.), can signal the presence of some systemic disease, so it is worth being examined carefully. Endocrinological disorders, intestinal diseases, hematopoietic organs, neoplasms can be detected - a malfunction in the work of any system of the body can make itself known by the appearance of ulcerative defects in the oral cavity.

The periodic appearance of small painful ulcers (sores) on the gums, which usually disappear after about 6-7 days, can be a symptom of chronic recurrent aphthous stomatitis. With constant trauma or against the background of decreased immunity, prolonged stress, they can spread throughout the oral cavity, the inner epithelium of the cheeks, appear on the lips, merge into one continuous ulcerative lesion. Treatment will be delayed, scars may remain on the surface after healing.

Herpetiform stomatitis, as the name suggests, resembles herpes in appearance, although it is not (a fairly rare form of aphthous stomatitis). These are multiple small painful ulcers without clear outlines with a grayish-whitish base, which can merge, forming one large lesion. The rashes are mainly located on the gums, the lower surface of the tongue and the sublingual area. They usually disappear in a week, maximum in ten days.

Setton's aphthae are small ulcers with raised, dense edges that appear on the inside of the lips, cheeks, and the sides of the tongue facing them. This is how recurrent necrotic periadenitis (a complication of inflammation of the submandibular lymph nodes) manifests itself. These aphthae usually do not spread to the top of the gum, but they can be located below. The aphthae are painful, the patient has difficulty eating, and sometimes he cannot even talk. A long course of up to several months is typical.

Fusospirochetosis (Vincent's ulcerative necrotic gingivostomatitis) usually begins on the gums at the site of constant trauma (crowns), near a decayed tooth or its absence. If not cured, it gradually affects the entire gum. Hyperemic, swollen gums are characteristic, loose and bleeding. The necrotic process begins at the tips of the papillae between the teeth, gradually affecting the entire gum. It is accompanied by intense pain. Necrotic plaque, hypersalivation, a rotten smell from the mouth appear, and a high temperature may rise.

The edges of the ulcer in the acute course of the disease have soft, uneven outlines, they are covered with an abundant layer of necrotic greenish-gray plaque with a pronounced putrid odor. Having removed it with a swab, one can find a loose, heavily bleeding bottom of the ulcer, surrounded by edematous inflamed tissues.

The clinical course of the disease can be mild, moderate and severe. Mild (local gum damage) – the patient’s condition is practically not affected, local discomfort is felt when chewing, drinking hot drinks. It is easiest to stop the process at this stage. In moderate – the course worsens, ulcers become more numerous, severe is usually accompanied by high temperature and other intoxication symptoms. The patient may refuse food and practically not talk.

Avitaminosis aphthae can be caused by hypovitaminosis C - a white ulcer on the gum itches and does not heal until the body receives the necessary amount of vitamin with food or a vitamin supplement. In addition to the formation of ulcers on the inflamed gums, a deficiency of this vitamin is accompanied by general weakness and numbness of the extremities, the entire oral cavity gradually becomes inflamed and covered with ulcers.

Vitamin B2 deficiency, in addition to ulcers on the gums and tongue, is manifested by dry, cracked lips, angular cheilitis, insomnia, lacrimation, nausea and vomiting.

Vitamin B6 deficiency in addition to ulcers - dry lips, dandruff, numbness of the extremities.

Irregular white ulcers on the inner surface of the gums, tongue and cheeks may indicate erosive leukoplakia.

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

Tuberculous - are a consequence of infection with Mycobacterium tuberculosis (in case of lung damage) of the oral mucosa in places of its integrity violation, including on the gum. At the site of introduction, a painful, rather rapidly growing tubercle appears, the loose base of which usually bleeds.

Gum tissues have good reparative properties and usually heal very quickly. Long-term non-healing ulcers on the gums may indicate their constant trauma, serious diseases: acquired immunodeficiency syndrome, malignancy, and also that the cause of their occurrence has not been determined correctly, treatment was only symptomatic and additional diagnostics are required.

Ulcer on the gum of a child

Such lesions appear for various reasons, any of the factors described above can provoke the appearance of ulcers on the gum. Poor oral hygiene at an early age provokes the appearance of Bednar's aphthae - erosive formations with a yellowish-whitish film on top. These ulcers also appear due to injury to the gum by something hard or solid (a toy, teeth).

The most common causes of mouth ulcers in children are viral, candidal, traumatic or allergic acute aphthous stomatitis. Viral stomatitis most often develops against the background of acute respiratory diseases, as well as childhood infections (chickenpox, rubella, measles). The symptoms are acute: weakness, capriciousness, hypothermia, loss of appetite, enlarged submandibular lymph nodes. The temperature peak coincides with hyperemia and swelling of the gums, on which vesicular rashes appear, followed by superficial erosive wounds. Severe pain and hypersalivation accompany this process. The lips dry out, cracks and crusts appear on them, causing significant discomfort to the child.

Aphthous stomatitis manifests itself by the periodic appearance of an ulcer on the gum of a child, the hyperemic gum in this area can bleed, swell. The child loses appetite, becomes irritable, gets tired quickly. In children, unlike adults, one or two ulcers usually appear, no more.

Allergic reactions usually manifest as a catarrhal form of stomatitis, sometimes with a hemorrhagic component. The gums itch, hurt, and become dry. In 2/3 of children, the lesion spreads from the gums to the entire oral mucosa - it swells, pinpoint bleeding appears, 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 disturbed.

Children may develop acute ulcerative gingivitis. This disease is generally typical for young people. In a child, it is a continuation of the catarrhal form. Symptoms of this disease are necrosis and multiple ulcers. This condition develops when the body's defenses are reduced in response to irritation of the gum tissue by opportunistic microbes 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 the presence of general diseases. This pathology is often preceded by teething in a child, acute respiratory infection, stress and other factors that contribute to a decrease in immunity. Catarrhal phenomena are always present before the appearance of ulcerative lesions. The first signs of the development of the inflammatory process are soreness and itching of the gums, redness, swelling. Congestion appears - the interdental papillae acquire a bluish tint, they bleed. The first ulcers are located there, the gum areas become necrotic and are covered with a dirty-gray or greenish plaque that is easily removed with a swab. The surface of the teeth is also generously covered with a soft plaque that is difficult to clean off. There is plaque on the tongue and sticky saliva. Even in areas of the oral cavity not affected by the inflammatory process, there is fibrinous plaque. The child's breath is unclean and putrid.

The course of the disease is long, accompanied by intoxication. The child has pain when chewing, eats poorly, loses weight, is capricious, and becomes irritable. His sleep is disturbed. If the child has no history of previous acute infectious disease or trauma due to abnormal tooth growth or bite, it is assumed that he has blood diseases, malignant reticulosis (if the child is under 10 years old). Older children may have an independent disease - fusospirochetal gingivostomatitis.

Complications and consequences

A frivolous attitude to the appearance of a gum ulcer and lack of treatment can lead to a more severe form of the disease with high fever and symptoms of general intoxication. Aphthae can spread over the entire surface of the oral cavity, become deep and reach the muscle or even tendon layer, bone tissue. When the depth of the aphtha reaches the jaw bone, osteomyelitis can develop in this area.

With the blood flow, the infection can spread throughout the body, causing an inflammatory process in distant organs, sepsis.

Long-term recurring catarrhal gingivitis can transform into hypertrophic fibrous gingivitis, requiring surgical intervention.

Fusospirochetal gingivostomatitis can spread to the palate and tonsils (Simanovsky-Plaut-Vincent angina). If help is not sought in a timely manner, irreversible complications may occur: osteolysis of bone tissue, gum recession, severe forms of periodontal inflammation, scars in areas of deep and extensive ulcerative lesions.

Even if the ulcers have passed without treatment, this does not mean that the infection has disappeared. Most likely, the process has become chronic and will bother its "owner" from time to time. Such a transition is most likely in the absence of oral sanitation or in the case of a general chronic disease.

Ultimately, 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 depend on the time of detection of the disease.

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

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Diagnostics gingival ulcers

If you find a single or multiple ulcers in the oral cavity, you should first of all contact a dentist. After examining and questioning the patient, tests may be prescribed - a clinical blood test, special tests - to determine the level of serum iron, B vitamins. Bacteriological blood culture and microscopy of a biopsy of the oral mucosa, an HIV test, and a Wasserman reaction may be prescribed. If there is a possibility of mercury intoxication, a test for mercury content in the urine is prescribed.

If systemic diseases are suspected, the patient will need to consult specialists - a gastroenterologist, dermatovenerologist, endocrinologist, phthisiologist or others depending on the suspected pathology. Instrumental diagnostics (ultrasound, tomography, radiography) may be prescribed.

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Differential diagnosis

Based on the examination data, differential diagnostics will be performed to exclude pathologies with similar symptoms and to identify a disease that requires treatment. They exclude infection with the human immunodeficiency virus, syphilis, blood diseases that lead to ulcers in the oral cavity, cancer of the oral mucosa, and differentiate Vincent's ulcerative necrotic stomatitis from stomatitis caused by other pathogens.

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Treatment gingival ulcers

Conservative therapy of gum ulcers is carried out in several directions: destruction of infection, relief of the patient's condition and strengthening of his immunity. Treatment of gum ulcers that appeared as a result of such serious infections as syphilis, tuberculosis, HIV is carried out in a hospital under the supervision of specialists.

For gingivitis, local medications are mainly prescribed. It should be noted that the drug will only be effective after cleaning the dental plaque at the dentist. After this procedure, appropriate treatment will be prescribed.

The antibacterial effect is provided by the Metrogyl Denta gel - a complex (metronidazole + chlorhexidine) agent for treating the oral cavity, it has an insufficiently high concentration (below therapeutic) of the antibacterial component, however, in some cases this is sufficient. The gel does not affect proinflammatory mediators, as well as local anesthesia.

A more effective antibacterial agent is Holisal-gel – a combination of choline salicylate (anti-inflammatory, antiseptic, analgesic effect) and cetyl chloride (bactericidal and fungicidal). It acts instantly, inhibits the action of cyclooxygenase – a catalyst for the synthesis of inflammation mediators. The gel can be applied to the gums two to three times a day – before meals to relieve pain, and after meals – to destroy microbes and relieve inflammation. This drug is approved for use from the age of one year, and can be used 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 ulcers, then rinse your mouth with Chlorhexidine and blot your gums with gauze or a cotton pad. Apply the gel with a clean finger not only to the front of the gum, but also to the inside. After this, you cannot drink for about half an hour or eat for two or three hours. Do not spit out saliva, but swallow it as usual.

In case of inflammation caused by viruses, antibacterial gels are absolutely useless. The doctor can prescribe Bonafthon ointment (0.5%), which is effective in case of infection with the herpes simplex virus. It blocks its development and growth processes. It is applied to the affected area twice or three times a day.

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

Herpetic stomatitis is usually accompanied by severe pain, Anesthesin ointment (active ingredient - benzocaine) is recommended as a pain reliever. Surface pain relief occurs within a minute after application. It can be used by both adults and children from the age of two. May cause allergies, not intended for nursing mothers. Sensitivity may be impaired at the site of application.

Benzydamine, a mouthwash solution that also has an additional anti-inflammatory effect, has pain-relieving properties.

According to practicing dentists, most cases of stomatitis, especially in children, are an allergic reaction. Children and adults who suspect they have an allergy are prescribed antiallergic drugs, such as Fenkarol (hiphenadine hydrochloride) - blocking H1 receptors and, in addition to this, stimulating the enzymatic activity of diamine oxidase, which breaks down almost a third of endogenous histamine. It surpasses classic antihistamines in activity, as well as duration of action. It is characterized by rapid action and does not cause pronounced sedation. Contraindicated in case of individual sensitivity and in the first trimester of pregnancy.

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

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

Ulcers are treated with antiseptics and local anesthesia is prescribed.

To remove bacterial plaque that slows down ulcer healing, furacilin, hydrogen peroxide, and carbamide peroxide are used. To speed up healing and activate the restoration of gum tissue, ointments with a keratoplastic effect (Solcoseryl, Methyluracil) are used.

A prerequisite for effective treatment of fusospirochetosis is meticulous treatment of the oral cavity, including the removal of dead tissue and deposits of supra- and subgingival tartar. During treatment, the oral cavity is washed with antiseptic solutions of chlorhexidine, potassium permanganate, hydrogen peroxide and others, with special attention paid to the edge of the gums and periodontal pockets. In the clinic, daily applications of solutions of proteolytic enzymes are prescribed, for example, Trypsin, which breaks down dead tissue and fibrinous clots, liquefies viscous secretion and exudation products, and relieves inflammation. At home, the patient can treat the gums with Maraslavin (a multicomponent antiseptic of plant origin), which, in addition, relieves pain, accelerates healing, reduces manifestations of allergies and the inflammatory process. Also at home, rinsing with warm antiseptic is recommended.

Broad-spectrum antibiotics are prescribed for severe or complicated cases (ulcerative necrotic tonsillitis) when local procedures do not have a quick effect. The anaerobic bacteria that cause the disease, spindle-shaped bacilli and Borrelia vincentii, are destroyed with broad-spectrum antibacterial drugs. They are sensitive to Clindamycin or Metronidazole.

According to indications, drugs to support cardiac activity, antihistamines,

Patients with Vincent's gingivostomatitis undergo regular medical examinations for a year after recovery.

Ulcerative necrotic gingivitis that develops due to pathologies of the hematopoietic system, scurvy, mercury poisoning, is treated with systemic therapy.

When treating ulcerative gum lesions of any etiology, the patient is necessarily prescribed vitamins: ascorbic acid, thiamine, pyridoxine and others at the doctor’s discretion, which help strengthen the body’s defenses.

Physiotherapy is widely used in the treatment of oral cavity inflammations. The effect of ultraviolet rays or d'Arsonval currents on aphthae is considered effective. Medicinal electrophoresis is used for pain relief and inflammation reduction.

In case of gum inflammation, including purulent gum inflammation, electromagnetic fields of ultra-high and super-high frequency can be used. Magnetic waves of centimeter range are used.

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

Physiotherapeutic procedures allow to achieve a therapeutic effect faster. When using them, the drug effect is minimized, thereby reducing the likelihood of side effects. Physiotherapy is usually well tolerated by patients of any age. Although there are a number of contraindications to the use of these treatment methods, in particular, neoplasms and blood diseases, metal prostheses in the area of action. Microwave and laser therapy are prohibited for pregnant women. Physiotherapeutic procedures are not prescribed during acute diseases and to patients with decompensated chronic pathologies.

Treatment at home

If the defect is isolated and 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 ulcer with home remedies. But at the same time, it should be taken into account that gum tissue has good restorative abilities and if a fairly quick positive result of the efforts made is not noticeable, do not delay in contacting a dentist. Perhaps the pathology requires a completely different treatment.

Ulcers that occur when the gums are injured by the sharp edges of an untreated tooth, a poor-quality crown, and other similar causes, first of all, require their elimination (refilling or treatment of the tooth, correction of malocclusion, or a defective prosthesis).

In this case, it is necessary to rinse your mouth several times a day with infusions of medicinal herbs (calendula, sage, chamomile), and in the morning it is advisable to rinse with a disinfectant solution, for example, soda or furatsilin. And then during the day after each meal, rinse the mouth with an infusion of some herb and lubricate the ulcers with a cotton swab with sea buckthorn oil. You can use Maraslavin, which is applied to canker sores and inflamed gums in the form of lotions. Without a prescription, you can buy Metrogil-denta gel at any pharmacy, which has a moderate antimicrobial effect, to speed up healing, you can use Methyluracil ointment. To reduce inflammation and disinfect, you can treat the oral cavity with Ingalipt or Lugol's solution in the form of a spray.

Viral stomatitis can be treated with antiviral ointments, while not forgetting to rinse your mouth with antiseptics (herbal infusions, potassium permanganate solution). Use pharmaceutical preparations according to their instructions.

An antiseptic solution for rinsing can be prepared as follows: dissolve four or five furacilin tablets 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 of soda to the solution. Rinse with a solution at room temperature or slightly warm during the day.

Potassium permanganate can also be used as a disinfectant solution. It must be filtered well to avoid undissolved grains that can cause a burn of the mucous membrane.

Traditional treatment of ulcerative gingivitis involves the use of both pharmaceutical preparations and those prepared at home. Traditional medicine recipes can be included in medical treatment regimens for oral cavity treatment at home. However, it is necessary to consult with your doctor first, since traditional remedies are not always compatible with medicinal ones.

To treat aphthous stomatitis, you can use the following remedy: crush a nystatin tablet into powder and grind it with the contents of an ampoule of vitamin B12 for injections. Apply this mixture to the aphthae and the inflamed part of the gum. The author claims that the beneficial effect of such treatment occurs almost immediately and recommends using this remedy to treat ulcers on children's gums.

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

Canker sores can be simply 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 small children.

You can lubricate your gums with honey mixed with almonds ground into a pulp. The remedy is also effective for herpetic stomatitis.

Aphthous stomatitis can be cured quite simply by regularly rinsing your mouth with hot water. Freshly squeezed carrot juice diluted with water, decoctions of oak bark or walnut leaves are used for rinsing the mouth.

You can also get rid of a gum ulcer with the help of herbal treatment. For example, rinse your mouth with infusions after eating at least twice a day:

• from the root of cinquefoil - brew 20g of the herb in ¼ liter of boiling water, strain after two hours;
• from elecampane herb - brew 50g of herb in ½ liter of boiling water, strain after half an hour;
• from thyme herb - brew a tablespoon of plant material in ¼ liter of boiling water, strain after half an hour.

A decoction of marigolds (calendula) is also used for rinsing, for which a tablespoon of dried flowers is brewed with ¼ liter of boiling water and boiled over low heat for another ten minutes, filtered and used to rinse the mouth.

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

However, do not forget that treatment with folk remedies can help only in cases where ulcerative gum disease is caused by completely harmless reasons. If ulcers appear regularly, this may indicate the presence of serious general pathologies. In this case, it is necessary to undergo a thorough examination.

Homeopathy

Homeopathic treatment, based on activating the body's own defenses, is safe (practically causing no side effects) and very effective, and copes perfectly with the formation of ulcers on the gums, even those caused by systemic chronic pathologies. Self-medication in this case is unacceptable, a consultation with a doctor of the appropriate qualification is necessary, since effective treatment is possible only with the correct prescription of an individual homeopathic drug. Children respond very well to homeopathic treatment.

In the treatment of ulcerative gingivitis, both constitutional remedies and those prescribed according to symptoms are used. Nux vomica (Nux vomica - vomit nut), Lycopodium (Lycopodium - club moss), Sulfur (Sulfur), Lachesis (Lachesis - snake venom), Tuya (Thuja), Mercurius solubilis (Mercury) and other drugs are often used. For example, Mercurius solubilis and Hepar Sulfur can be prescribed in case of purulent ulcers, however, other properties of the drug are also taken into account when prescribing. Its action is also affected by homeopathic dilution. Thus, high dilutions of Hepar Sulfur stop the formation of pus and act resorptively, and low ones can promote suppuration. The same drug can be used for problems with the eruption of wisdom teeth. For allergic ulcers, Apis (Apis is bee venom) is prescribed, usually in medium dilutions.

Vincent's gingivostomatitis can be successfully treated with Belladonna, Phytolacca, and Capsicum.

For aphthous stomatitis, the doctor may recommend Mercurius solubilis (mercury), Borax (borax), Calendula officinalis (calendula), Nitricum acidum (nitric acid).

An individually prescribed drug can bring fairly quick relief from pain, inflammation and other discomfort, and also help eliminate the underlying disease. But, it should be noted that despite the small doses and lack of side effects, homeopathic drugs should not be taken on your own. If prescribed incorrectly, they can cause a number of painful symptoms.

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

Nux vomica (Nux vomica or vomit nut) stops inflammatory processes along the entire length of the esophageal tract from the oral cavity (gingivitis and stomatitis) to the colon and rectum of microbial and neurological etiology, as well as due to excessive consumption of alcoholic beverages and tobacco products

Bryonia (Bryonium or white bryony) – has analgesic properties, affects the mucous membranes.

Lycopodium (Lycopodium or club-shaped diving bean) – anti-inflammatory and analgesic effect, including on the oral mucosa.

Colocynthis is an antispasmodic that relieves inflammation and intoxication.

Sensitization reactions to the ingredients of the drug are possible. The drops are taken a quarter of an hour before or an hour after meals, diluting them in half a glass of water and drinking three times a day at equal intervals, without swallowing immediately and holding them in the mouth for some time. Dosage: children 0-1 year old - nine drops per day, 2-6 years - 15 drops, patients over 6 years - 30 drops. A single dose of the drug can be diluted in a teaspoon: children 0-1 year - three drops, 2-6 years - 5 drops, patients over 6 years - 10 drops and taken sublingually three times a day.

To cleanse the body, relieve intoxication and inflammation, take in combination with complex homeopathic preparations Renel (in addition, it enhances the analgesic effect) or Lymphomyosot (improves lymph flow, enhances the immunostimulating effect).

Surgical treatment

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

Excision of hypertrophied interdental papillae using a surgical scalpel (gingivectomy) is practiced.

If erosive leukoplakia is diagnosed, excision of the lesions with subsequent histological examination of the removed tissue samples is also recommended in order to detect the malignant process earlier.

Malignant neoplasms that manifest as gum ulcers are subject to surgical treatment.

Prevention

The risk of developing a gum ulcer is significantly reduced in people who lead a healthy lifestyle – do not smoke, do not drink, and eat properly.

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

Vitamin therapy is also important, especially during infectious diseases and long-term drug therapy. Strengthening the immune system is the key to preventing relapses of gum ulceration.

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Forecast

Since the appearance of a gum ulcer can be caused by various reasons, the prognosis completely depends on the etiology of the defect. In most cases, ulcers are removable and gum tissue heals quickly and safely.

In general, with mild and moderate degrees of gingivitis, the general state of health does not change significantly and the ability to work is usually not lost. With timely measures - oral cavity sanitation, correction of prosthesis defects, etc., improvement occurs within the first day and ulcers are epithelialized within a few days. In the case of more severe forms of the disease, treatment can drag on for months, however, the prognosis is generally favorable.