Gingivitis

GINGIVITIS (from Latin gingiva-gums), inflammation of the gums. Redness, swelling with edema, tenderness, bleeding with slight pressure on the gum characterize this disease, appearing more or less sharply in its various forms, sometimes complicated by ulceration and tearing of the gum edges and partial necrosis. The occurrence of this disease can be caused by both local and general causes. Among local causes, unhygienic condition of the oral cavity and, in particular, neglected carious processes of the teeth are foremost. Next, factors contributing to chronic 2 3 gingivitis trauma to the gums play a role, which prepares the ground for local infection (deposition of dental calculus, poorly fitted crowns, fillings hanging onto the gums, dentures, bad habits of cleaning teeth after meals with objects that traumatize the gums). Special attention should be paid to occupational hazards in the etiology of gingivitis. Thus, in stonecutters, cement plant workers, glass and pearl polishers, the harmful effect on the gums is mechanical irritation by dust from these industries; often mechanical irritation is accompanied by chemical and infectious irritation. For example, wool dust can cause mechanical irritation by small hair particles and simultaneously cause infection of the gums (contamination of the wool).-Further, G. is often caused by irritation by halogens, ammonia, acids, toxic chemical compounds both with direct action and with internal administration (mercury, bismuth); finally-by carbon disulfide and lead white [in rubber (galosh) production].- General causes of G. are certain pathological conditions of the body, as well as such conditions as puberty, menstruation, pregnancy. Therefore, in some cases, the condition of the gums should be considered as a symptom. For example, there are observations of swelling of the gums and their bleeding with active tuberculosis of the lungs and their return to normal with the subsidence of the tuberculous process. General anemia, severe infections accompanied by high temperature and weakness, scurvy and a number of other diseases that undermine nutrition are usually accompanied by lesions of the gums. - On the t.-a the t. changes in various forms of G. are not the same. However, the difference lies not so much in the anatomical substrate as in the predominance of one or another picture of inflammation (proliferation, exudation) or simply necrosis of the mucous membrane. Clinically, the following forms of G. are distinguished. Atrophic G. (gingivitis atrophicans). To this form, Parch (Parch) proposes to include a mild inflammatory condition of the gums with signs of atrophy and a beaded thickening of their edges. Atrophy is manifested by exposure of the roots of the teeth. There is a small serous-purulent discharge from under the gums and deposition of calculus on the teeth. A variety of this form is gingivitis atrophicans denudans. Here, the exposure (retraction) of the gum is most sharply manifested. This form is observed on individual teeth, more often on canines, on the vestibular (buccal) side. The detached gum appears as a small pocket with a thinned mucous membrane. The edge of the gum has a tendency to longitudinal, along the axis of the tooth, splitting (tearing); the place of the latter is painful, which makes chewing and tooth brushing difficult.-Catarrhal gingivitis ^(gingivitis catarrhalis s. simplex) [see color plate, appendix to the article Grip (t. VIII), fig. 1]. The process may cover small areas or may be widespread on all gums. In acute cases, it is characterized by redness of the gums, in chronic cases-the edge of the gum takes on a bluish tint (stagnation phenomenon) with a small serous-purulent discharge from under the gums and bleeding.-Treatment of this and the previous form consists in eliminating local causes that can cause and maintain G., and in paying attention to the general condition of the patient. Dental calculus must be removed with special care.-Sometimes catarrhal forms of gingivitis turn into hypertrophic ones (gingivitis hypertrophica), which are characterized by intensive growth of the gums, especially between the dental papillae [see color plate, appended to the article Grip (vol. VIII), figure 2]. Depending on the duration of the process, the gum appears either more loose or dense. In the first case, increased bleeding of the gums is noted. The growth is sometimes so pronounced that it covers the crowns of the teeth, forming deep gum pockets. Treatment consists in eliminating local causes. In the initial stages, astringent and cauterizing agents help-Zincum chloratum (10-50%), Arg. nitricum, Acid, trichlorace-ticum, etc. More reliable is the excision of the growths with a scalpel. The line of incision should pass at the level of the boundaries (bottom) of the pocket and repeat the normal festooned edge of the gums; removal of dental calculus is required. On the 5-7th day after such an operation, the gum takes on a normal appearance. Hemorrhagic gingivitis (gingivitis haemorrhagica) is mainly encountered in Barlow's and Werlhof's diseases and in acute leukemia. Inflamed, sharply swollen, filled with blood like a sponge-gums are painful, easily injured, with persistent bleeding. From the mouth- a foul odor. The success of local treatment depends on the general treatment of the underlying diseases, - G. of specific origin. Mercury G. (gingiv. mercurialis) is characterized by swelling of the gums and itching in them. The initial severe redness of the gums is then replaced by ulceration of their free edges. Gingiv. mercurialis, with insufficient care, can be complicated by simple or ulcerative stomatitis with loosening of the teeth. Smears from the gum pockets reveal a pronounced fusospirochete. Prevention plays an exceptionally important role in this disease. It consists in the hygienic maintenance of the mouth in workers dealing with mercury, and in patients who are to be treated with mercury preparations, the oral cavity should first be put in order and at the same time abundant rinses with disinfectant solutions should be prescribed. With developed mercury G., treatment consists in thorough cleaning of the interdental spaces and areas with putrefactive decay. It is carried out with a stream of some disinfecting and deodorizing solution (hydrogen peroxide, potassium permanganate) from a syringe, and even better-from an Esmarch's cup. Additionally, these places should be cleaned with cotton swabs soaked in the same solutions and fixed on a Miller's needle or dental probe. The cleaned places are cauterized with a 20% solution of trichloroacetic acid, 20-50% solution of Arg. nitr. (it should be kept in mind that discoloration of the teeth may occur), copper sulfate, resorcinol, zinc chloride, etc. In addition-frequent rinsing (H₂O₂, Kal. hypermang., Kal. chloric., etc.)- Internally-aspirin. Treatment, vigorously carried out from the very beginning, usually gives good results.-Lead G. (gingiv. saturnina) represents the usual catarrhal G. or, in more severe cases, has the character of the initial stage of mercury G. A feature is the so-called lead line of the gums in the form of a grayish-violet line (see Lead, poisoning). Local treatment for lead gingivitis is the same as for catarrhal G. It is useful to periodically lubricate the gum with T-ra Jodi. General treatment: baths, potassium iodide internally.-Other types of G. of specific origin, such as in phosphorus poisoning, irritation by pearl dust, etc., are usually not singled out in separate chapters, as they do not have characteristic specific features, just like G. of pregnant women, diabetic and others.-Ulcerative G. (gingiv. ulcerosa s. ulcero-membranacea) is rarely observed localized, as it quite quickly passes into the picture of ulcerative stomatitis and is better known under the name stomatitis ulcero-membranacea, stomacace. Remaining localized, ulcerative gingivitis appears as a dirty-gray coating on the free edges of the gums. After removal of the decay, a bleeding ulcerative surface is revealed. There is abundant salivation and a foul odor from the mouth, general malaise, often subfebrile temperature. The pain of the ulcers makes eating difficult, which leads to a vicious circle-deterioration of nutrition worsens the process, and patients, due to pain, avoid eating. Treatment of ulcerative G. requires great attention from the doctor and patience from the patient. Local treatment is carried out in the same way as in developed mercury G. Attention should also be paid to the general condition.