Chronic hypertrophic gingivitis
Chronic hypertrophic (hyperplastic) gingivitis is a chronic inflammatory process of the gum tissue, accompanied by its growth. The basis of the occurrence of chronic hypertrophic gingivitis is changing in the hormonal status in endocrine diseases, during puberty, during pregnancy, and menopause).
The development of chronic hypertrophic gingivitis is promoted by general diseases (leukemic reticulosis), chronic intoxication, taking certain medications (nifedipine, carbamazepine, cyclosporine).
Chronic hypertrophic gingivitis is manifested by an increase in the volume of the papillae with the formation of false periodontal pockets. Epithelial gingival attachment in chronic hypertrophic gingivitis is not disturbed. There are also no pathological changes in the bone tissue of the alveoli in chronic hypertrophic gingivitis.
Forms of chronic hypertrophic gingivitis
According to clinical and morphological changes, edematous and fibrous forms of chronic gingivitis are distinguished. The morphologically edematous form of hypertrophic gingivitis is manifested by edema of the connective tissue elements of the gingival papillae, vasodilatation, swelling of collagen fibers, and lymphoplasmacytic tissue infiltration.
The clinical picture of the edematous form of hypertrophic gingivitis will be manifested by the patient's complaints about the aesthetic defect due to the unusual appearance of the gums, their pain when brushing their teeth, and while eating. When examining the oral cavity, the gingival papillae are enlarged, edematous, hyperemic, or cyanotic, bleeding during probing. The papillae have a glossy surface; after pressing on the surface of the papilla, a depression remains with the blunt part of the instrument. Dental deposits may be found.
The morphologically fibrous form of hypertrophic gingivitis is manifested by the proliferation of connective tissue elements of the gingival papillae, coarsening of collagen fibers, and parakeratosis. Edema and inflammatory tissue infiltration in the case of the fibrous form of hypertrophic gingivitis are not expressed.
The clinical picture of the fibrous form of hypertrophic gingivitis is manifested by the patient's complaints about the unusual appearance of the gums and the associated aesthetic defect. When examining a patient with a fibrous form of hypertrophic gingivitis, enlarged gingival papillae are determined, they are pale pink, dense to the touch; soreness and bleeding are absent. Hard and soft subgingival dental deposits can be found.
Diagnostics of hypertrophic gingivitis
Diagnostics of hypertrophic gingivitis is usually straightforward. To assess the patient's dental status, it is enough to question, examine, palpate the gums, probing clinical pockets, Schiller-Pisarev's test (with edematous form). In doubtful cases, an X-ray examination is indicated.
To exclude blood disease, all patients should undergo a general blood test. Patients with hypertrophic gingivitis should be consulted by specialist doctors of the appropriate profile (gynecologist, endocrinologist, hematologist, etc.); in some cases, an in-depth study of the patient's hormonal status is required.
Treatment of chronic hypertrophic gingivitis
Treatment of chronic hypertrophic gingivitis is carried out taking into account etiological factors, morphological picture, and clinical form of the disease.
Treatment of the edematous form of hypertrophic gingivitis
In the edematous form of hypertrophic gingivitis, treatment begins with anti-inflammatory therapy:
- removal of dental deposits
- applications of anti-inflammatory and antimicrobial agents
- the appointment of anti-inflammatory physiotherapy (galvanization, electrophoresis, darsonvalization)
With the ineffectiveness of the listed measures in the edematous form of hypertrophic gingivitis, sclerotherapy is indicated. It is carried out by imposing on the edge of the gums and introducing into the clinical pockets tampons moistened with various sclerosing compounds: 20-30% resorcinol solution, 10-25% zinc chloride solution, 5-10% alcoholic propolis solution. At home, with an edematous form of hypertrophic gingivitis, rinses and mouth baths with herbal decoctions are prescribed.
With the ineffectiveness of application sclerotherapy in the edematous form of hypertrophic gingivitis, they resort to injecting hypertonic solutions into the gingival papillae of such drugs as 10% calcium chloride solution, 40-60% glucose solution, 10% calcium gluconate solution, 90% ethyl alcohol solution (deep sclerosing therapy). The introduction of sclerosing agents in the edematous form of hypertrophic gingivitis is performed under anesthesia.
Steroid hormones are also used as decongestants for the edematous form of hypertrophic gingivitis, for example, injections into the papillae of 0.1-0.2 ml of hydrocortisone emulsion. Also effective is daily rubbing into the gingival papillae of ointments, which include glucocorticoid hormones ("Ftorocort", "Lorinden", "Deperzolone", "Hyoxysone"). Glucocorticoids can also be used in gingival dressings.
With the ineffectiveness of conservative treatment for the edematous form of hypertrophic gingivitis, excision of the hypertrophied gingival margin is performed - a gingivectomy operation.
Gingivectomy for the edematous form of hypertrophic gingivitis is performed under anesthesia in the area of 6-8 teeth simultaneously. Excision of the hypertrophied gums is performed with an incision, which starts closer to the transitional fold and goes obliquely to the bottom of the "false" pocket. In this case, only the outer part of the hypertrophied gingival margin is excised.
Treatment of the fibrous form of hypertrophic gingivitis
With the fibrous form of hypertrophic gingivitis, the use of cytotoxic drugs, for example, novembichin, is shown: 10 mg of the drug is dissolved in 10 ml of isotonic sodium chloride solution and injected into the hypertrophied papillae, 0.1-0.2 ml weekly; for a course of 3-5 injections.
With the fibrous form of hypertrophic gingivitis, point diathermocoagulation of hypertrophied gingival papillae is effective. The operation for the fibrous form of hypertrophic gingivitis is performed under anesthesia. The electrode (root needle) is inserted into the papilla tissue to a depth of 3-5 mm. In one session, 4-5 papillae are coagulated.
However, most often, with the fibrous form of chronic hypertrophic gingivitis, they resort to surgical excision of the overgrown gums - gingivectomy operations.
In pregnant patients with a fibrous form of hypertrophic gingivitis, dental deposits are removed, and anti-inflammatory therapy is performed. If the condition of the gums does not return to normal after childbirth, sclerotherapy and surgical methods are used.
In juvenile (adolescent) hypertrophic gingivitis, they take a wait-and-see attitude, all efforts are focused on maintaining a good hygienic state of the oral cavity. Treatment of chronic hypertrophic gingivitis is performed if the pathological changes in the gums do not disappear after the end of puberty.
With leukemia, dentists carry out only symptomatic therapy for chronic hypertrophic gingivitis. Sclerosing agents, physiotherapeutic and surgical methods of treatment are contraindicated in this situation.