Inflammation of the gums - periodontal disease. Gingivitis and periodontitis. Symptoms, diagnosis and treatment of gum inflammation.

It is believed that periodontal inflammation develops with the participation of periodontopathogenic microorganisms, the action of which manifests itself when the balance between the protective forces of the human body, organs and tissues of the oral cavity and bacterial infection is disturbed [11, 19]. Of all the branches of periodontology, practitioners are certainly most interested in the issues of adequate and effective drug treatment of inflammatory periodontal diseases.

Unfortunately, in the treatment of periodontal diseases there is no multidisciplinary approach, and internists are rarely involved in the treatment process. Usually, so-called monotherapy is carried out, in which a specialist of one profile is involved - usually a dentist-therapist. With the so-called complex treatment, all stages are carried out in random order, in the absence of an algorithm for complex therapy, without clear preliminary planning and subsequent objective assessment of the effectiveness of each stage, taking into account the individual characteristics of the patient, without a medical examination program and supportive therapy [1, 21].

The purpose of this message is to inform dentists specializing in periodontology, interns, clinical residents, senior dental students about the main directions of drug therapy for inflammatory periodontal diseases, which are most widely used today in Russia.

Based on our own experience and data from domestic literature, we can propose the following course of action for the dentist.

The authors have made every effort to ensure the accuracy of the information presented, including drug dosages. Aware of our responsibility associated with the preparation of the publication, and taking into account the constant changes occurring in medical science, we recommend that the dosage of medications be updated according to the appropriate instructions.

1.What is gum disease and its causes?

Gum disease is an infection of the tissue and bone that surrounds and supports the teeth in the jaw. Another name for this disease is periodontal disease.

There are two types of gum disease:

• Gingivitis
  is a gum disease that affects only the gums, the soft tissue around the tooth;
• Periodontitis
  is a more serious problem. Periodontitis spreads below the gums, damaging the tissue and bone that support the teeth.

Causes of gum disease

Inflammation of the gums is caused by the growth of bacteria on the teeth and gums.

. Bacteria live in plaque on teeth. Bacteria feed on the sugars in the food we eat and produce toxins and other chemicals. Toxins irritate your gums, causing them to become inflamed and bleed when brushing your teeth. Over time, plaque and clear plaques can harden and form tartar. This irritates the gums even more.

The likelihood of developing periodontal disease increases in those people who brush their teeth poorly or do it irregularly. In addition, risk factors for gum inflammation include

:

• Smoking or chewing tobacco. These patients have gum problems much more often and the problems are usually more severe than in other patients. Gum disease often leads to tooth loss and is difficult to treat.
• Heredity – relatives have problems with gums.
• Health problems that weaken the immune system - severe stress, diabetes, AIDS, leukemia.
• A diet low in vitamins and minerals, as well as excessive consumption of sweets and carbohydrates.

A must read! Help with treatment and hospitalization!

Diagnosis of periodontitis: how to assess the condition of periodontal tissues

For an accurate diagnostic examination, you need to visit a periodontist - this doctor specializes in the treatment of periodontal tissue. The assessment of the condition must be carried out in a comprehensive manner - remember that a visual examination alone is not enough, it is impossible to assess the condition of the bone tissue and determine the degree of development of the consequences of periodontitis, especially at its initial stage, when there is no clear visualization of the entire picture of the pathological process. Diagnosis at this stage is carried out in the traditional way:

1. visual examination and history taking - communication with the patient, clarifying the nature of the pain, the frequency of exacerbation of the disease, the degree of bleeding, as well as clarifying how well and by what means hygiene is carried out at home,
2. measuring the depth of periodontal pockets using special instruments - probes, scalers, etc. The obtained indices (depth from the existing gum level and natural cement level) are entered into the patient’s card - including for comparing indicators in the future and assessing the effectiveness of treatment,
3. computed tomography to assess the degree of resorption (destruction or loss) of bone tissue,
4. microflora culture to assess the type of bacteria causing the inflammatory process, as well as their sensitivity to various drugs - this will allow the doctor to select the most effective drugs. Not a broad spectrum of action, but those that will act specifically on a specific pathogen of the pathological process. This analysis is performed directly in our clinic twice - before the start of treatment to select tactics, and after - to evaluate the result,
5. blood tests - general clinical, for sugar levels, if necessary - to determine the level of hormones and the amount of certain vitamins. Our body is an integral structure where everything is interconnected. It is important for us to understand what exactly caused periodontitis and whether it is a consequence of the development of some other disease (for example, leukemia, tuberculosis, diabetes, etc.).

Read more about how diagnostics are carried out in our separate article.

“Our patients do not need to go anywhere else - all necessary diagnostics are carried out within our clinic and are already included in the cost of complex treatment. We make an accurate diagnosis, identify the cause of periodontitis and select individual solutions. Yes, the complex is designed for a long-term solution, but only through joint efforts can we cope with the problem of periodontitis.”

Orlova Elena Vladimirovna, dentist-therapist, periodontist, work experience over 32 years make an appointment

We know how to treat periodontitis! We will save your teeth and eliminate constant inflammation thanks to the latest advances in medicine! Consultation and diagnostics FREE

Solve the problem right now

2. Symptoms of gum inflammation, or symptoms of periodontal disease

Healthy gums are pink and regular in shape. They fit tightly to the tooth and do not bleed.

Symptoms of gingivitis

are:

• Redness, swelling and sensitivity of the gums;
• Bleeding gums when brushing teeth or flossing.

Gingivitis usually does not cause pain, so people do not always pay attention to the symptoms of this disease and do not immediately consult a good dentist.

Symptoms of periodontitis

easier to notice. It could be:

• Retraction of gums from teeth;
• Bad breath that you can’t control;
• Pus in the gum area;
• Changes in the position of teeth relative to each other;
• Loosening and even loss of teeth.

If you suspect that you have gum disease, you should contact a good dentist immediately. Prompt treatment of periodontal disease will help prevent the progression of the disease.

Visit our Therapy page

Treatment of gums, teeth and oral mucosa

Before talking about methods of treating them, it is necessary to draw a certain demarcation line, because other diseases are often mistakenly attributed to gum diseases. We are talking primarily about stomatitis. Stomatitis is commonly referred to as lesions of the oral mucosa (in particular the inside of the lips, cheeks and tongue). Although the exact causes of stomatitis have not yet been determined, one fact remains clear: stomatitis is not associated with periodontal disease, so classifying it as gum disease is incorrect. With another common dental problem, periodontitis, things are less clear. Periodontitis is one of the most unpleasant complications of caries; it affects the apex of the tooth root, not the gum.

As a result, we will talk about the three most common periodontal diseases, which negatively affect soft tissues. These are gingivitis, periodontitis and periodontal disease.

4. Treatment of the disease

Timely treatment of gum inflammation is very important. It will help prevent irreversible gum damage and tooth loss and control infection. To prevent this from happening, at home you need to brush your teeth twice a day and use dental floss, stop smoking and visit the dentist regularly.

antibiotics to treat gingivitis.

to help fight infection. The antibiotic can be applied directly to the gums or in the form of tablets, capsules, or mouthwash. Antibacterial toothpaste will help combat dental plaque and gum inflammation with regular use.

For periodontitis

professional teeth cleaning
procedures to remove plaque and tartar above and below the gum line.

If periodontal disease has reached a very serious stage and the teeth and gums are severely damaged, surgical manipulation

. Treatments for gum inflammation may include:

• A gingivectomy can help get rid of pockets between your teeth and gums;
• A special operation is performed to clean the tooth root and repair the damaged bone;
• If other measures fail, your doctor may remove severely loose or very damaged teeth.

After surgery, you may need to take antibiotics and other medications to help heal and prevent infection. Antibacterial mouthwashes and regular brushing after treatment will help keep your gums healthy.

Treatment of hyperplastic (hypretrophic) gingivitis

At the first stage, the same set of measures is provided as for catarrhal gingivitis.

If the treatment is ineffective, sclerotherapy is indicated: injections into the gingival papillae of sterile hypertonic solutions (10% calcium chloride or gluconate solution, 40% glucose solution, 90% ethyl alcohol). The administration of 0.1-0.3 ml of such solutions is carried out under local anesthesia. The injection is carried out with a thin needle from the top of the papilla to its base simultaneously in 3-4 papillae. The interval between injections is 1-2 days, the course is 4-8 injections. Pregnant women with this form of gingivitis do not undergo sclerotherapy.

Treatment of ulcerative-necrotizing gingivitis

Includes:

• relief of acute gum inflammation;
• reducing intoxication of the body, increasing the resistance of the body and periodontal tissues;
• elimination of local unfavorable factors that may contribute to the progression of the inflammatory-destructive process.

The treatment plan repeats the sequence of medical actions for other inflammatory periodontal diseases, but there are some features [10, 19, 20]:

• professional hygiene is carried out in stages under local anesthesia (applications, oral baths with lidocaine solution; if necessary, infiltration or conduction anesthesia);
• at the first visit, only supragingival dental deposits are removed;
• other local measures are carried out as the inflammatory process subsides.

It is important that both the doctor when seeing a patient and the patient at home use antiseptics that release atomic oxygen and chlorine-containing solutions, which have an adverse effect on the anaerobic microflora. Acceleration and facilitation of the removal of necrotic tissue from the surface of the gum lesion is ensured with the help of proteolytic enzymes. To optimize the epithelization of tissues (after cleansing them from a film of necrotic tissue), keratoplasty preparations are used.

Systemic (general) therapy for patients with necrotizing ulcerative gingivitis includes (Table No. 1):

• antibacterial drugs (beta-lactam antibiotics - penicillins and cephalosporins), tetracycline antibiotics, macrolides, antiprotozoal drugs (metronidazole);
• anti-inflammatory drugs;
• vitamins, adaptogens;
• hyposensitizing agents.

Criteria for assessing the effectiveness of complex treatment of inflammatory periodontal diseases can be:

• improvement of the patient’s general condition;
• relief of inflammation - in acute gingivitis;
• stabilization of periodontal status - with periodontitis;
• improvement of parameters assessed by additional research methods.

We are far from thinking that we were able to take into account and present all aspects of complex therapy, and especially drug therapy, for inflammatory periodontal diseases, and we admit that some of the materials were not included in this publication. Therefore, all constructive comments from readers will be received with gratitude.

For readers interested in this issue, we provide a list of recommended literature.

LITERATURE

1. Abaev Z. M., Domashev D. I., Antidze M. K. et al. Modern methods of treatment and prevention of periodontal diseases // Dentistry. - 2012, No. 4. - P. 72-74.
2. Wolf G.F., Rateitzhak E.M., Rateitzhak K. Periodontology; lane with German; edited by G. M. Barera. - M.: MEDpress-inform, 2008. - 548 p.
3. Goncharova E.I. Herbal remedies in the prevention and treatment of periodontal diseases // Ros. stoma magazine. - 2012, No. 3. - P. 48-52.
4. Grudyanov A.I. Periodontal diseases. — M.: Publishing house “Med. information agency", 2009. - 336 p.
5. Grudyanov A.I., Aleksandrovskaya I.Yu. Planning of therapeutic measures for periodontal diseases. — M.: LLC “Med. information agency", 2010. - 56 p.
6. Grudyanov A.I., Ovchinnikova V.V., Dmitrieva N.A. Antimicrobial and anti-inflammatory therapy in periodontology. — M.: LLC “Med. information agency", 2004. - 80 p.
7. Periodontal diseases. Modern view on clinical, diagnostic and therapeutic aspects: study. village, recom. UMO MH&SR and Ministry of Education. RF / Yanushevich O. O., Grinin V. M., Pochtarenko V. A., Runova G. S. et al.; edited by O. O. Yanushevich. - M.: GEOTAR-Media, 2010. - 160 p.
8. Krazhan D.S., Garazha N.N., Orlov M.N., Morgoeva Z.Z. Potentiated effect of antiseptics and sorbents on the microflora of periodontal pockets // Med. Bulletin of the North Caucasus. - 2012, No. 2. - P. 40-42.
9. Lobko S. S., Khomenko A. I., Shadurskaya S. K., Petruk A. A. Therapeutic dentistry: Etiotropic therapy of marginal periodontal diseases: Textbook. allowance. - Mn.: BSMU, 2001. - 70 p.
10. Makeeva I.M., Kudryavtseva T.V., Erokhin A.I., Akulovich A.V. Periodontal diseases: a guide. to practice therapist classes. dentistry for students IV and V courses of stoma. faculties. - MEDpress-inform, 2009. - 96 p.
11. Makeeva I.M., Smirnova T.N., Chernousov A.D. et al. The use of lactoferrin in the complex treatment of dental diseases (literature review) // Dentistry. - 2012, No. 4. - P. 66-71.
12. Müller H.-P. Periodontology; lane with him. - Lvov: GalDent, 2004. - 256 p.
13. Patient management plans. Dentistry / ed. O. Yu. Atkova, V. M. Kamenskikh, V. R. Bosyakova. - M.: GEOTAR-Media, 2010. - 240 p.
14. Platonov I. A., Andreeva T. A. Workshop and methodological guidelines on pharmacology. Part 2. Ed. prof. I. A. Platonova. - Smolensk, 2009. - 106 p.
15. Modern aspects of clinical periodontology / Ed. L. A. Dmitrieva. - M.: MEDpress, 2001. - 128 p.
16. Therapeutic dentistry: national. manual / ed. L. A. Dmitrieva, Yu. M. Maksimovsky. - M.: GEOTAR-Media, 2009. - 912 p.
17. Filatova N.A., Elizova L.A., Chekhova N.O., Kostryukov D.A. Possibilities of achieving stabilization of the inflammatory process in periodontitis // Int. scientific-practical conf. "Achievements and prospects in dentistry." - 1999. - T. 1. - P. 257-260.
18. Tsarev V.N., Ushakov R.V. Antimicrobial therapy in dentistry: Guide. — M.: Med. information agency, 2004. - 144 p.
19. Tsepov L. M. Periodontal diseases: a look at the problem. - MEDpress-inform, 2006. - 192 p.
20. Tsepov L. M., Nikolaev A. I., Mikheeva E. A. Diagnosis, treatment and prevention of periodontal diseases. — 3rd ed., rev. and additional - MEDpress-inform, 2008. - 272 p.
21. Tsepov L. M., Nikolaev A. I., Nesterova M. M. et al. System doctor - patient - periodontal pathology: reasons for suboptimal interaction that reduces the quality of dental care // Dental South. - 2012, No. 8. - P. 28-29.
22. Yudina N. A., Lyugovskaya A. V., Kurochkina A. Yu. Antimicrobial therapy in the treatment of periodontal diseases: educational method. allowance. - Minsk: BelMAPO, 2008. - 42 p.

How is gum disease treated?

At the DentoSpas dental clinic, periodontal treatment is carried out by doctors with a narrow specialization. It is possible to use drug therapy, hygiene, preventive procedures, and surgical interventions. Treatment is performed in several stages:

• diagnostics: the doctor examines the oral cavity, assesses the condition of the periodontium, and interviews the patient. At the diagnostic stage, additional studies may be required: taking diagnostic images, conducting laboratory tests (blood tests, scrapings, if you need to determine the causative agent of an infectious disease);
• relieving inflammation. This requires sanitation: treatment of diseased teeth, professional hygiene to remove mineralized plaque, cleaning periodontal pockets. To stop the spread of infection and relieve inflammation, the doctor may prescribe antibiotics and anti-inflammatory drugs;
• surgery. May be required for severe inflammation or gum recession. The doctor will restore gum tissue and perform splinting to strengthen loose teeth;
• implantation, prosthetics. Needed if the patient has already lost one or more teeth. It is necessary to restore the dentition so that the chewing load is distributed correctly and new periodontal diseases do not appear.

Periodontists at the DentoSpas clinic note that all gum diseases are easier and faster to treat at an early stage. If you consult a doctor when the inflammation is just beginning, it can be easily removed. If the disease progresses, more complex and expensive treatment will be needed.

How much does gum treatment cost in Moscow?

We can only talk about prices for gum treatment in Moscow in a general way, since everything depends on the disease and its specific manifestations. For example, treatment of simple gingivitis with a diode laser will cost on average 1,000 rubles per tooth, and complex therapy for periodontitis costs 10,000 - 20,000 rubles per jaw (depending on the stage of the disease and the level of the clinic). In this case, medications, antibiotics and hygiene products are paid for separately by the patient. As for complex periodontitis and periodontal disease, it is difficult to give even an approximate amount of treatment. For this, curettage is often used (1,000 - 2,000 rubles per tooth), as well as plastic surgery of hard and soft tissues: the cost of this surgical procedure depends on the volume of treatment and the drugs used. If the patient’s teeth are very loose, the doctor usually suggests splinting, which on average costs 2,000 rubles per tooth.

Periodontology