What is acute necrotizing ulcerative gingivitis?
Acute necrotizing ulcerative gingivitis has many names. Vincent gingivitis was first reported in 1898. Because Vincent reported that the disease was caused by mixed infection of Clostridium and spirochete, it was called Clostridium spirochete gingivitis. Because this disease was prevalent among frontline soldiers during World War I, it was called Mizoguchi disease. Traditional Chinese medicine calls it odontopathy.
Acute necrotizing gingivitis mainly occurs in young people aged 18 ~ 30, and it is more common in men. Its onset is acute and the course of disease is short (several days to two weeks). It is characterized by necrosis of interdental papilla and marginal gingiva. At the beginning, the gingival papilla was congested and edematous, and the interdental papilla was red and swollen, with a complete appearance. Some interdental papillae are sunken in the center like craters, covered with gray and dirty necrosis. The lesion quickly spread to the adjacent nipple and marginal gingiva, making the gingival margin like a moth, and the surface was covered with necrotic pseudomembrane, which was easy to erase. The necrotic area is often bounded by the narrow "red edge" between normal gums, and the lesion generally does not spread to the attached gums. Gums are prone to bleeding, with obvious pain or swelling of teeth, and sticky saliva. There is typical rotten bad breath. Mild people generally have no systemic symptoms, and severe people may have low fever, fatigue and submandibular lymph node enlargement. If not treated in time in the acute stage, necrosis can spread to adjacent tissues and form necrotizing gingivitis.
Because of repeated acute attacks or incomplete treatment, it will turn into chronic necrotizing gingivitis. The interdental papilla is seriously damaged or even disappeared. If the interdental papilla of several consecutive teeth is damaged, the gingival margin will turn inward. The buccal and lingual sides of the gums at the interdental papilla are separated and can be opened from the tooth surface. There is tartar and soft scale on the lower tooth surface, and the gums are generally not necrotic. If not treated in time, it can cause alveolar bone absorption and periodontal pocket formation, which is called necrotizing ulcerative periodontitis.
In the treatment of acute phase, the first step is to gently remove necrotic tissue and scrape off large stones. Use oxidant such as 1% ~ 3% hydrogen peroxide for local washing and repeated washing. Vitamin C and other supportive treatments were given to the whole body. In severe cases, oral metronidazole (metronidazole) 0.2g, three times a day. And timely oral hygiene education, change the toothbrush.
What is gingivitis?
Gingival papillitis is an acute nonspecific inflammation, which is limited to individual interdental papillae. It is mainly caused by mechanical and chemical stimulation at the interdental space, such as food impaction, improper tooth picking, hard object stabbing, adjacent surface caries and so on. Bad restorations, such as the overhang of fillings and the stimulation of denture clasp, are also possible reasons.
The clinical manifestations are bright red swelling of interdental papilla, easy bleeding during aspiration, spontaneous swelling or tenderness during aspiration. Some female patients have aggravated menstrual pain. When suffering from acute gingivitis, some patients may have obvious spontaneous pain and moderate pain caused by cold and heat stimulation, which is easily confused with gingivitis. There will be a slight knocking pain in the teeth.
During the treatment, dental calculus, dental plaque, food residue, etc. The adjacent surface should be removed first, and the interdental space should be washed with 1% ~ 3% hydrogen peroxide solution, and then coated with a layer of bactericidal astringent, such as iodine glycerin. After the acute inflammation subsides, the etiology should be removed, such as modifying the bad prosthesis and filling the adjacent caries. Attention should be paid to prevent irritation of gingival papilla during treatment.
What is acute multiple gingival abscess?
Acute multiple gingival abscess is a rare acute gingival inflammation with obvious characteristics, and its etiology is unknown at present. It may be related to trauma. Most of them are young and middle-aged men, and they often have chronic gingivitis before they get sick. The disease often occurs suddenly in spring and autumn. Before the onset, there were fatigue, fever, dry mouth or cold, tonsillitis and other precursor symptoms. In the early stage, the gingival papilla was bright red, swollen and the saliva was sticky. After taking general anti-inflammatory drugs, it is ineffective, and then most of the interdental nipples are swollen and painful. A small abscess is formed in each swollen gingival papilla, which ruptures spontaneously after a few days and can spread to the buccal and lingual gingival papilla of the same tooth at the same time, forming abscesses respectively. Affected teeth and adjacent teeth are sensitive to impact. Oral mucosa can generally be red and swollen, but there is no ulcer and false membrane. The patient developed symptoms such as elevated body temperature, leukocytosis, local lymphadenopathy and constipation. The disease is difficult to control, abscesses occur one after another, and the course of disease is often as long as 1 ~ 2 weeks or even longer.
The effect of antibiotic treatment alone is average. Most of them are treated with integrated traditional Chinese and western medicine. For fulminant patients, when systemic symptoms are obvious, in addition to effective and sufficient antibiotics, traditional Chinese medicines such as Wei Qing Decoction, Geliang Powder and Wuwei Disinfection Drink should also be taken orally. It is necessary to do local treatment such as cleaning, descaling and drainage in time. After the acute symptoms are controlled, periodontal local treatment should be carried out immediately to completely eliminate inflammation and prevent recurrence. Generally, the gums can return to normal after healing, and there will be no tissue damage. For generalized gingival abscess with poor curative effect after long-term treatment, systemic diseases such as diabetes should be ruled out.
What is the most common gingivitis and can it be prevented?
Chronic simple gingivitis, also known as marginal gingivitis or gingivitis, is the most common and easy to occur in gingivitis. Almost every adult may have chronic gingivitis of different degrees and ranges at some time in his life. It is based on the long-term accumulation of plaque on the tooth surface at the gingival margin. Dental calculus, poor repair, food impaction, oral breathing and other factors will aggravate the accumulation of dental plaque and gingival inflammation.
Generally, mild simple gingivitis only invades the wandering gingiva and gingival papilla, and can affect the attachment of gingiva in severe cases. The affected gums are red with blood stasis and edema, bright and soft. The gingival margin becomes thicker and does not stick to the tooth surface. The interdental papillae became round, dull and hypertrophy. Bleeding when the gums are touched, brushed or bitten. What's more, gingival margin erosion, granulation hyperplasia, gingival pocket overflow pus. The gingival sulcus can be deepened by swelling, exceeding 3mm, and the bottom of the gingival sulcus is still located in the crown of enamel cementum. X-ray film shows that alveolar bone has no obvious absorption.
It can be cured within a few days to 1 week after removing the cause. It is feasible to thoroughly clean dental calculus, control dental plaque and correct all factors that cause dental plaque retention and stimulate gums, such as correcting bad restorations and food impaction, filling adjacent caries and adjusting occlusion. Teach patients the correct ways to brush their teeth and rinse their mouths after meals. External use of drugs such as iodine glycerin to eliminate inflammation.
Chronic simple gingivitis can be prevented, and the key is to thoroughly remove dental plaque every day, that is, brush your teeth in the right way every morning and evening, and remove dental plaque and food impaction from adjacent teeth with dental floss and toothpicks.
Is hypertrophic gingivitis just gingival hypertrophy?
Hypertrophic gingivitis is not only gingival hypertrophy, but also a chronic inflammatory disease of gums. This is a disease in which gingival tissue is locally stimulated, such as plaque, tartar, oral respiration, malocclusion, unfilled holes, poor repair and so on. With the proliferation of cells and collagen fibers, gingival tissue is enlarged.
The early stage is mainly inflammation, which mostly occurs in the lips and gums of the upper and lower front teeth. Dark red or dark red in color, soft and bright, easy to bleed. The gingival margin is thick, and the gingival papilla is spherical and enlarged, even covering some tooth surfaces. The depth of gingival sulcus is more than 3mm, but the attachment position of combined epithelium is still at the boundary of enamel cementum, which is called pseudo periodontal pocket or gingival pocket. At this time, a large number of capillaries in the gingival sulcus are congested and dilated, a large number of inflammatory cells and tissue fluid ooze, connective tissue is granulation-like, and collagen fibers are not regenerated. Some patients, such as those with a long course of disease, have relatively mild gingival inflammation, tough and substantial hypertrophy of gingival papilla and gingival margin, hard and elastic texture, and less red or close to normal color. At this time, inflammatory infiltration in gingival connective tissue is limited, and there are a large number of fibroblasts and new collagen fiber bundles, which is called proliferative gingivitis.
First of all, we should remove all local stimulating factors and maintain good oral hygiene. Scale carefully; Teach patients how to control plaque; Correct oral breathing, such as treatment of nasal diseases, lip muscle training for those with short upper lip, wearing vestibular shield at night or applying vaseline to the gums on the labial side of front teeth to reduce gum exposure and dryness. For a few patients whose gingival volume can't be close to normal after inflammation is eliminated, gingivoplasty can restore the physiological shape of gingiva, which is beneficial to the control of dental plaque. Periodontal packing and gum massage can be supplemented after scaling, and patients should be educated and supervised to seriously implement plaque control measures and review regularly to prevent the recurrence of hypertrophic gingivitis.
What is the most common gum disease in adolescence?
Teenagers are most likely to suffer from chronic nonspecific gingivitis. Women are slightly more common than men. Due to the endocrine changes at this stage, gingival tissue has obvious inflammatory response to a small amount of local stimulation. There are local irritants in the affected area, such as the crowded part of malocclusion, the habit of oral breathing, the part where teeth are erupting and replacing, and the part where teeth are undergoing orthodontic treatment. Gingival tissue has vascular hyperplasia and tissue edema, which is not easy to distinguish from hypertrophic gingivitis.
It is characterized by onset in adolescence. Interdental papillae and gingival margin are common on the labial side of anterior teeth, but lingual gingiva is rare. The labial interdental papillae is often spherical, and the gums are bright red or dark red, soft, bright and edema, and easy to bleed. The degree of gingival hypertrophy and inflammation is more serious than local stimulation.
The treatment begins with scraping the tartar. It is necessary to teach patients the knowledge and methods of maintaining oral hygiene to get through this age, so that they can really master the methods of controlling dental plaque. Slightly swollen gums can usually be cured after basic treatment. Patients with excessive hypertrophy and hyperplasia need surgery, but as long as local stimulation exists, patients who are still in adolescence will still relapse after surgery. For adolescents receiving orthodontic treatment, the existing gingivitis should be cured in advance, and the design and manufacture of orthodontic appliances should be conducive to the control of dental plaque and avoid irritation to periodontal tissue. During the treatment of 1 ~ 2 years, periodontal examination and treatment were carried out regularly.
Why does gum bleed during pregnancy?
After 2 months of pregnancy, pregnant women often have obvious gingival bleeding and even interfere with diet, which is due to gingivitis during pregnancy. Pregnancy itself will not cause gingivitis, but the change of sex hormone level during pregnancy will aggravate the original chronic gingivitis and change its characteristics. During pregnancy, the level of female hormones (mainly progesterone) in the body increases, which makes the gingival capillaries dilate, congestion, inflammatory cells and fluid exudation increase, which aggravates the inflammatory reaction. However, local irritants and dental plaque are important triggers of gingivitis during pregnancy. If there is no irritation or plaque, gingivitis will not occur during pregnancy. Individual lesions are confined to the interdental papilla and look like tumors, which are called gestational tumors. In fact, it is not a tumor, but a proliferation of capillaries, which exceeds the response of gums to chronic stimulation, leading to nipple enlargement.
Patients generally have varying degrees of gingivitis before pregnancy. Symptoms begin at 2-3 months of pregnancy and peak at 8 months. Two months after delivery, gingivitis mostly fell back to the pre-pregnancy level.
Inflammation can occur in individual teeth or complete teeth, especially interdental papilla, and the anterior tooth area is more serious than the posterior tooth area. It is characterized by bright red or dark red gums, which are extremely soft and bright, and it is easy to bleed when touched, and sometimes even automatically. Generally, there are no pain symptoms. In severe cases, ulcers and false membranes can be formed at the gingival margin, and there is mild knocking pain. Teeth will loosen. Gingival sulcus deepened.
First of all, we should carefully and gently remove all local stimulating factors, such as tartar, dental plaque, bad restorations, oral cavity filling, etc., and at the same time carry out detailed oral health education. Try to avoid using anti-inflammatory drugs such as antibiotics, so as not to affect the fetus. For some pregnancy tumors that are large and hinder eating, they can be surgically removed. However, the operation time should be chosen as far as possible between the fourth and sixth months of pregnancy. The resection should reach the bone surface, including periosteum, to avoid recurrence. If the original gingivitis can be treated in time in the early pregnancy and the dental plaque is carefully controlled, the occurrence or recurrence of gingivitis during pregnancy can be prevented.
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