Papillae grow from the gums between the teeth. Gingivitis (inflammation of the gums) - types and forms (catarrhal, hypertrophic, ulcerative, necrotic, acute and chronic), causes of the disease, symptoms (bad breath, pain, bleeding, etc.), diagnostic methods,

Common problem: Loss of gingival papillae and the appearance of “black triangles”.

Loss of gingival papillae, especially in the anterior maxilla, is a serious aesthetic problem and can cause significant psychological discomfort in patients with a high smile line.

The World Health Organization defines health as physical and psychological well-being. Therefore, dentists should strive to improve the patient’s appearance when restoring teeth (bridges, veneers, composite restorations) and gum correction. In other words, the goal of dental care is to ensure the physical and psychological well-being of the patient by optimizing the aesthetics of the teeth and gums.

Due to the prevalence of loss of interdental papillae and the aesthetic defects associated with this condition, there is a need to solve this problem (Fig. 4-3a and 4-3b).

Effective solution: Measuring biological width using bone probing.

In 1961, Gargiulo et al published the results of measurements of the depth of the periodontal sulcus, epithelial and connective tissue attachment, i.e. biological width (Fig. 4-3c). It is known that violation of the biological width leads to the development of gingivitis and periodontitis, even with careful oral hygiene (Fig. 4-3d). Tarnow et al." revealed an inverse relationship between the probability of filling the interdental space with the gingival papilla and the distance between the interdental contact and the alveolar ridge (Fig. 4-3).

In the past, dentists paid attention to the location of the contact point solely for reasons of preventing food from entering the

Rice. 4-Pros. A forced smile does not bring satisfaction to the patient. There are “black triangles” between the teeth

Rice. 4-ЗБ. Patient's smile line

Rice. 4-3d. When carrying out treatment, the biological width was not taken into account, which led to the development of gingivitis, despite careful hygiene

Rice. 4-Ze. The probability of the gingival papilla filling the interdental space depending on the distance between the contact point and the bone edge (Tarnow et al.

interdental space and, taking this circumstance into account, prosthetics were performed, including the anterior group of teeth (Fig. 4-3f and 4-H). The coronal boundary of the interdental contact is determined by aesthetic criteria, and the apical boundary depends on the distance to the alveolar bone (Fig. 4-3h).

In an article devoted to the features of the dentogingival complex, Kois

described the use of periodontal parameters in prosthetic treatment planning and a method for determining the contour of the alveolar ridge margin. It was this author who first demonstrated the feasibility of probing the bone before prosthetics.

After local anesthesia has been administered, the periodontal probe is inserted until it makes contact with the bone (Fig. 4-3i.

Rice. 4-3f. Symmetrical arrangement of contact points in the anterior part of the upper dentition.

and 4-3j), the obtained values ​​are documented in the patient’s chart (Fig. 4-3k). In the future, these data can be used to create a composite restoration, orthodontic movement of teeth and the manufacture of prosthetics, such as veneers and crowns (Fig. 4-31 and 4-3).

Without a thorough analysis of the parameters of the dentogingival complex, it is impossible to achieve predictable regeneration of the gingival papillae (Fig. 4-3p).

The application of the technique described above and the use of the obtained data when performing prosthetics allows us to obtain a satisfactory result (Fig. 4-3).

Rice. 4-Zd. Wax-up of upper anterior teeth (Kubein-Meesenberg et al.

). Localization of contact points is determined using interproximal cones

Rice. 4-3h. The relationship between the apical border of the interdental contact point and the level of the alveolar ridge (Tarnow et al.

Rice. 4-3j. Probing the bone crest

Rice. 4-3i. Measuring the size of the gingival papilla and the distance between the bone level and the contact point

Rice. 4-Zk. Documenting indicators in a special form

Doctor of Dentistry, private practice (periodontics and prosthetic dentistry) (Leon, Spain)

Doctor of Dentistry, private practice (periodontology) (Pontevedra, Spain); Associate Professor at the University of Santiago de Compostela

In order for the restoration to look natural and the restored teeth to perform their function correctly, it is necessary to take into account the structure of the gums, the appearance of the lips and the patient’s face as a whole. Mucogingival surgery is available to treat gum recession.

Interdental gingival papilla- This is the area of ​​gum between two adjacent teeth. It not only serves as a biological barrier that protects periodontal structures, but also plays a significant role in the formation of the aesthetic appearance. The absence of interdental gingival papillae can lead to problems with pronunciation, as well as the retention of food debris in the interdental spaces.

If the interdental gingival papilla is lost, its regeneration is quite difficult. Only a few such cases are known in dental practice. However, none of the reports contain information about methods that can restore the gingival papilla. This report describes a surgical method for restoring mucosa and gingival papilla in the pontic pontic area in the presence of bone deficiency.

Surgical technique

The patient, 45 years old, came to the clinic for treatment of periodontal pathology. She complained about the mobility of the two upper central incisors. The patient wanted to restore her appearance and also eliminate periodontal pathology. The central incisors had mobility of the 3rd degree, the depth of the pockets during probing was 10 mm and 8 mm. In the area of ​​the right lateral incisor, a periodontal pocket with a depth of 10 mm was also found in combination with a vertical bone defect, which indicated a deficiency of bone tissue under the gingival papilla (Fig. 1 a, b).

Rice. 1a. Recession found on the labial side of teeth 11 and 12

Rice. 1b. Recession found on the labial side of teeth 11 and 12

A 7 mm deep pocket was also found in the area of ​​tooth 22.

When collecting anamnesis, no allergies, concomitant diseases or bad habits were revealed. The patient was classified as ASA class 1. Several weeks before surgery, the patient was taught oral hygiene, in addition, subgingival deposits were removed and root surfaces were cleaned. After removal of granulation tissue in the area of ​​the gingival papilla in the area of ​​the 12th tooth, soft tissue recession to a height of 3 mm was discovered. In accordance with Miller's classification, she was assigned class III. On the vestibular side, in the area of ​​teeth 11 and 12, soft tissue recession to a height of 2 mm was also detected (Fig. 2).

Rice. 2. Vertical defect and class III mobility of teeth 11 and 21

Due to the loss of bone around the two central incisors, the decision was made to remove them (Fig. 3).

Rice. 3 a - d. The first large connective tissue graft was used in the area of ​​the intermediate part of the bridge to protect the interincisal gingival papilla. We made sure that the temporary prosthesis does not put undue pressure on the graft

When smiling, the patient's gums were partially exposed (no more than a third of the length of the coronal part). At the same time, the color of the gum mucosa was heterogeneous. Photographs, x-rays were taken, alginate impressions were taken and masticography was performed. Based on digital analysis of photographs, diagnostic models were made, which were then placed in the articulator. The patient was then given treatment options. A tooth-supported bridge represents the most current option for replacing missing teeth, especially as an alternative to complex vertical guided bone regeneration, which would require frequent examinations and strict patient compliance. The use of such a prosthesis is less risky than installing an implant-fixed prosthesis if bone and soft tissue are not present in sufficient quantities. The patient had a high sociocultural level and aesthetic preferences. Taking into account other personal factors, in particular the patient’s place of residence, we were forced to choose the fastest, most effective and reliable solution. During her first three visits to the hygienist, the patient cried. Given her emotional instability, we abandoned a comprehensive therapeutic approach to reduce the risk of psychological trauma and possible failure. After the existing problem was explained to the patient, she agreed to remove two central incisors, correct the gums in the area of ​​the intermediate part of the bridge, as well as the gingival papilla using several connective tissue grafts. On the same day, after appropriate preparation of the canines and lateral incisors, a temporary fixed prosthesis was installed. The neck of tooth 12 was prepared accordingly, taking into account the likely future soft tissue reconstruction. Endodontic treatment of the lateral incisors was required. Silicone impressions were made to create a second, more accurate, long-lasting temporary prosthesis and to re-evaluate the case from a biological, functional, and esthetic perspective. Four weeks later, soft tissue recession was detected due to bone resorption on the vestibular side of the maxillary alveolar process.

First, a large connective tissue graft was used (Fig. 4).

Rice. 4 a - d. After the second stage of surgery, the volume of tissue in the area of ​​the right central incisor and the papilla between it and the lateral incisor was increased

Using several soft tissue incisions, a tunnel was created in the area of ​​the pontic pontic (Fig. 4). A 6-0 nylon suture was used to secure the graft. We ensured that the temporary prosthesis did not place undue pressure on the graft (Fig. 4). Then we took a break for 4 months. At the end of the period, an increase in the volume of soft tissues was revealed, which still remained insufficient (Fig. 5).

Rice. 5 a - d. The connective tissue graft was installed using a tunnel approach after frenectomy

We needed more tissue in the area of ​​the right central incisor and the gingival papilla between teeth 11 and 12. The depth of the pocket during probing is 7 mm (Fig. 5). Given the loss of 3-4 mm of papilla tissue, we can conclude that the probable probing depth was 10 mm with a 5 mm bone defect at the level of the papilla. After this, the second phase of surgery began (Fig. 5). The preoperative status of the interdental gingival papilla was determined using the Norland and Tarnow classification. The interdental gingival papilla, vestibular and palatal gingiva were numbed with local anesthesia using 1 capsule of Ultracaine® (articaine HCl/epinephrine, 40/0.005 mg/ml) and 1:100,000 epinephrine solution. For better visualization of the surgical field, a surgical dissecting loupe was used. First, a semicircular incision was made at the mucogingival junction to reposition the labial frenulum (Fig. 6).

Rice. 6 a - d. A diamond cutter was used to remove part of the transplanted epithelium

The second incision was made with a microscalpel from the lost gingival papilla along the gingival sulcus around the neck of the lateral incisor. The blade was turned towards the bone. The incision was made through the entire thickness of the gum tissue and provided access for a mini-curette. The third incision was made along the apical border of the semicircular incision directly in the direction of the bone (Fig. 6). As a result, a gingival-papillary complex was formed. Its mobility was necessary to create free space under the gingival papilla and install a connective tissue graft. In addition, some mobility of the palate tissue was also ensured. The resulting flap was fixed coronally using a curette directed along the gingival sulcus and a small periotome. The amount of donor tissue required was determined during a preoperative assessment of gingival and incisal height in comparison with the expected new location of the gingival papilla. A section of connective tissue of significant size and thickness with a section of epithelium 2 mm wide was taken from the patient’s palate (Fig. 5). An area of ​​epithelium was taken to obtain denser and more fibrous connective tissue, as well as to better fill the space under the coronally fixed tissue flap. The use of a large volume of tissue increased the chances of successful graft engraftment, since the graft was nourished by blood perfusion from a larger area. An area of ​​epithelium was placed on the buccal side of the coronally fixed tissue flap, but was not covered by it (Fig. 6), since epithelium is denser than connective tissue and therefore better suited as a base for the repositioned flap. The connective tissue portion of the graft was placed in the gingival sulcus of the lost gingival papilla to prevent movement of the tissue flap and retraction of the papilla (Fig. 6). A 6-0 nylon suture (interrupted suture) was used to secure the graft in position and stabilize the wound. This microsurgical approach was made possible by using a Zeiss optical microscope. The wound on the palate is closed with a continuous suture. The patient is prescribed amoxicillin (500 mg, three times a day, 10 days), as well as an alcohol-free mouthwash with chlorhexidine (twice a day, 3 weeks). Keratinizing epithelial cells and food debris could be removed from the wound surface using a cotton swab soaked in chlorhexidine gluconate. After 4 weeks, the stitches were removed. The patient was also prohibited from using mechanical means to clean teeth in the wound area for 4 weeks. An earlier examination of the patient was impossible due to the remoteness of her place of residence. The postoperative period passed without complications. The third stage of surgery took place before installation of the permanent prosthesis. Using a diamond cutter, part of the transplanted epithelium was removed (Fig. 7).

Rice. 7 a - c. Transformation of the intermediate part of the bridge after the first and second operations

The area between the pontic and the lateral incisors was not probed for 6 months. As a result of probing, a gingival pocket with a depth of 5 mm was discovered in the area of ​​the lateral incisor, which was only 1 mm greater than the depth of the gingival pocket in the area of ​​tooth 22.

results

The patient's condition was assessed 3 months after the first surgical procedure. Only horizontal tissue growth was achieved in the pontic pontic area (Fig. 8).

Rice. 8 a, b. After the second stage of surgical intervention, the edge of the soft tissue of the gingival papilla was 3-4 mm closer to the incisors than before the operation, while there was no bleeding, and probing did not give negative results

The depth of probing in the area of ​​the lateral incisor before the second operation was 7 mm. A recession of 3 mm in diameter was found in the area of ​​the right lateral incisor (Miller Class III). After the second stage of surgical intervention, the edge of the gingival papilla was 3-4 mm closer to the incisors than before the operation. The depth during probing decreased by 4-5 mm. An examination carried out after 2 years showed that the clinical results recorded 3 months after surgery had improved. In particular, there was no black triangle between the artificial crowns of the lateral and central incisor (Fig. 9 a, b).

Rice. 9 a. When checked after two years, no black triangle was found between the lateral and central incisors

Rice. 9 b. When checked after two years, no black triangle was found between the lateral and central incisors

There was no retraction or compression of the papillary tissue, and the probing depth did not increase. Radiographic examination showed improvement in the condition of the underlying bone (Fig. 10).

Rice. 10 a - d. Radiographic examination showed significant improvement in the condition of the underlying bone, although no bone graft was used

The depth of the gingival groove of the papilla is greater than on the opposite side, there is no bleeding, and probing does not give negative results. The success of the procedure depended on the following factors:

• The space between the bone and the coronally fixed gingival papilla was filled with a connective tissue graft.
• The connective tissue was well stabilized by the suture.

conclusions

In clinical cases that present not only a medical but also an aesthetic problem, reconstructive surgery can mask tissue loss, but the patient rarely achieves an ideal appearance. To improve the results of such intervention, periodontal plastic procedures can be used. The use of optics and microsurgical instruments is recommended. This allows the surgeon to improve visibility, avoid unnecessary incisions, and increase the chances of a favorable treatment outcome.

The health and beauty of your teeth depends on the health of your gums. The gap between the teeth is filled by the gingival papilla. This is a sensitive and vulnerable part of the soft tissue. Household injuries, improper oral hygiene, and dental diseases can lead to inflammation and excessive growth of the gingival papillae.

You can get rid of gum problems using cauterization. The procedure has a scary name for the average person. In fact, everything goes quickly and painlessly, thanks to modern technologies and drugs.

Features of gums between teeth

The areas of gum that fill the spaces between the surfaces of dental crowns are called gingival or interdental papillae. Interdental papillae protect periodontal structures. Incorrect formation or absence of structures leads to problems:

• violation of correct pronunciation;
• retention of food debris in the interdental space;
• aesthetic inconveniences.

Gingival papillae cover the spaces between teeth

Gingival papillae are a very sensitive and vulnerable part of the soft tissue. They are easily damaged from mechanical impact and violations of oral hygiene rules.

The health of teeth and gums depends on the condition of the interdental spaces. Therefore, you need to carefully monitor them and seek help from a specialist at the first symptoms of disturbances.

Inflammation of interdental papillae

Inflammation of the gingival papilla can occur due to a number of reasons. The first symptom of the disorder is bleeding and redness of the gum surface.

Causes of inflammation of the interdental papillae:

• Household injuries (using a toothpick, flossing, too hard a toothbrush, hard food).
• Injuries during therapeutic dental treatment, stone cleaning.
• Diseases of teeth and gums.
• Malocclusion.
• Hormonal disorders.

Constant violation of the integrity of the papilla tissue leads to bleeding and the entry of foreign microorganisms into the wound.

Inflammation of the gingival papillae - gingivitis

The process of inflammation of the papillae on the gums is characterized by regular bleeding (usually observed after brushing teeth or eating), and increased sensitivity. The damage will begin to heal after the natural completion of the inflammatory process. But if it grows excessively, the surface of the nipple will increase in size. The overgrown area of ​​the gum will become even more sensitive and vulnerable, new inflammation and bleeding cannot be avoided. Self-medication in a situation with inflammation of gum areas should not be practiced, otherwise it will be more difficult for the doctor to understand the causes of the disorder.

Gingival recession with enlarged papillae

How to treat inflammation of the gingival papillae

You should contact your dentist if you experience regular gum bleeding; this will save you from many troubles. Even a small problem with gum health cannot be ignored and left to chance.

When the gingival papilla grows, a coagulation procedure is performed. The gums are burned with electric current. The procedure is carried out very carefully, under local anesthesia. The patient does not feel pain, but discomfort may be observed after the procedure.

Coagulation in dental practice

Coagulation (diathermocoagulation) is one of the methods of surgical dentistry, used for the treatment and plastic surgery of soft tissues. The practice became widespread. Today there is equipment that allows many operations to be performed using electrode excision.

Coagulation in dentistry is cauterization. The operating instrument is heated by electricity. The therapeutic effect of diathermocoagulation of the gums is ensured by high-frequency alternating current. The current voltage is low, but the power is 2A.

If the operation is successful, the affected area becomes white. The effect is aimed primarily at blood vessels. Alternating current affects the inner surface of the vascular wall and promotes blood clotting. Due to this, damaged blood vessels are quickly closed, and bleeding gums are eliminated.

Coagulation of the gingival papilla allows you to quickly and reliably disinfect the wound, stop the development of the inflammatory process, and stop bleeding. Using this method, you can return an overgrown nipple to its former healthy appearance.

When is coagulation used in dentistry?

Coagulation is a serious surgical method. Its use in practice requires certain qualifications. The procedure can be carried out after an accurate diagnosis has been made.

Indications for the use of diathermocoagulation:

• Chronic pulpitis, pulp polyp.
• Periodontal inflammation (the contents of the tooth root canals are disinfected by cauterization).
• Removal of benign neoplasms of the oral mucosa (papillomas, hemangiomas, fibromas).
• Gingivitis, cutting off of overgrown gum nipples.

Using coagulation, the contents of periodontal pockets are disinfected. If enlarged blood vessels are visible in the mouth, they can also be removed using an electric current.

When should coagulation not be used?

The use of coagulation is contraindicated in the following cases:

• treatment of baby teeth;
• individual intolerance to the effects of electric current;
• narrowing or enlargement of the root canal of the tooth;
• unformed root tips.

The coagulation procedure is contraindicated for people with heart and vascular diseases.

A qualified specialist will definitely ask the patient questions about his state of health. You need to tell everything, indicate if you are allergic to anesthesia, and inform about taking medications.

Set for electrocoagulation procedure

How is coagulation of the gingival papilla performed?

Coagulation of the gums can be carried out using different techniques, methods and instruments.

There are several ways to carry out the coagulation procedure in dentistry:

• Action with a heated instrument. An outdated technique, rarely used today.
• Cauterization with an electrocoagulator. All modern clinics are equipped with these devices.
• Laser action. The safest and gentlest treatment method.

The choice of method depends on the equipment of the clinic and the characteristics of the disease. Each technique has its own advantages and disadvantages.

Heated tool

The tools for cauterizing the gums are a spatula, a dental trowel, or a plugger. Today the method is outdated.

Treatment of the gums with a heated instrument allows you to remove small areas of tissue. Using technology, they stop bleeding and cauterize wounds.

Gums immediately after coagulation

When performing the procedure, it is important to ensure complete sterility of the instrument.

Electrocoagulator

An electrocoagulator is a special device that operates at high frequency current. The main part of the tool is the loop. It is heated by electricity and cauterizes the desired area of ​​the gum or oral mucosa. Dental electrocoagulators are either stationary or portable. You can adjust the power of the device and select different operating modes.

The device operates silently. Its effect on humans is painless (the procedure is performed under anesthesia) and safe.

Laser

Laser therapy is widely used not only in cosmetology, but also in dentistry. This is the most advanced technology for removing overgrown gums. The radiation acts quickly, reliably and painlessly.

The main advantages of laser therapy are that after the procedure there are no traces or wounds on the gums, the sore spot is completely disinfected. You cannot get an infection during laser treatment, even if you really want to.

Laser plastic surgery of gingival papillae

If you have a choice about which method to use, it is better to give preference to laser.

Electrocoagulation technologies

Coagulation of the gums with the help of devices can be carried out using two different technologies. They differ in the depth of the influence of current on a person.

Electrocoagulation technologies:

1. Bipolar. Electricity is passed only through the desired area (through the gum). The current short circuit occurs at a short distance. With the help of bipolar technology, you can only get rid of small tumors on the gums. An end plate is not required when using the technique.
2. Monopolar. Electricity passes through the entire human body. With the help of technology, you can get rid of serious and deep-seated gum problems. To close the electrical circuit, the patient must wear a return plate.

Dentists prefer monopolar technology. It is more versatile and reliable. Monopolar electrocoagulation should not be used for people with heart and vascular diseases, intolerance to the effects of current, or for pregnant women at any stage.

Healthy gums, free from growths, tumors and inflammation, are the basis of a beautiful smile. If the gums become inflamed, the interdental papillae turn red and begin to bleed, this is a reason to consult a dentist. Overgrown gingival nipples can be removed using the electrocoagulation method. The procedure should only be entrusted to a qualified specialist.

Gingivitis, periodontitis - behind these incomprehensible names lies a dangerous disease for teeth associated with inflammation of the gums, which, if left untreated, can lead to tooth loss.

What are the causes of this disease and how to deal with it correctly?

Today, more than half of humanity suffers from inflammation of the gums, and the reasons for this are very different - from poor lifestyle to poor heredity or disruption of the body due to hormonal changes.

In this case, inflammatory processes can differ in the nature of their course and treatment methods. In order to correctly decide on therapy and know what to do, you should familiarize yourself with all the possible nuances.

Causes of the inflammatory process

The reasons for the development of inflammatory processes in the gums can be both external and internal. They also differ in the scale of impact. It is the correctly identified cause of inflammation that becomes the key to effective treatment.

General factors

Gum problems can result from:

• smoking;
• lack of minerals and vitamins in the body;
• diseases of the gastrointestinal tract and cardiovascular system;
• diabetes mellitus;
• hormonal imbalances;
• infectious processes;
• taking certain medications (for example, antidepressants, birth control, or nasal drops may have a negative effect);
• reduced immunity.

Local factors

These include:

• teething;
• injury, thermal or chemical burns of the gums;
• development of dental calculus;
• poor oral hygiene, accumulation of toxin-producing microorganisms;
• improper prosthetics or filling, in which the gum is injured by the overhanging edge of the crown or filling (inflammation localized within one or two teeth occurs).

The photo shows examples of gum inflammation

Gingivitis - we will survive this trouble

The listed factors quite often lead to the development of such dangerous inflammatory processes in the gums as gingivitis and periodontitis. In this case, a generalized nature of inflammation is observed, implying damage to the entire oral cavity.

This form of inflammation occurs most often. The disease can be provoked by both general and local factors.

The following symptoms are characteristic of this type of inflammatory process:

• slight swelling, bleeding and redness of the gums;
• changing the acute shape of the gingival papillae to a dome-shaped one;
• the appearance of an unpleasant odor and taste, itching sensation;
• soreness of the gums upon contact with food;
• fever, general weakness;
• formation of abundant plaque (at the initial stage).

A mild form of the disease (only the gingival papillae are affected) can be replaced by moderate and severe forms with damage to the free part of the gums and their entire space, respectively.

The photo shows a chronic process, the cure of which will require an integrated approach.

Ulcerative gingivitis

In this case, inflammatory processes affect the mucous membranes of the gums, provoking the development of tissue necrosis near the gingival margin and inflammation of regional lymph nodes.

The most likely cause of this process, along with hypothermia, infectious diseases and reduced immunity, is poor oral hygiene.

Symptoms characteristic of catarrhal gingivitis include:

• the presence of dirty gray plaque at the top of the gingival papillae, the removal of which leads to bleeding gums;
• temperature rise with increased heart rate, pale skin and loss of appetite.

When this form of the disease develops, it is extremely important to start treatment in a timely manner.

The photo shows a severe form of the disease with purulent inflammation, which requires antibacterial and surgical treatment.

Hypertrophic gingivitis

A feature of this form is the reactive proliferation of connective fibrous tissue and epithelial basal cells, caused by chronic inflammation of the mucous membranes of the gums. Most often, such disorders are caused by changes in the functioning of the endocrine system, lack of vitamins and metabolic disorders.

The following symptoms of the disease appear:

• thickening of the epithelium (if untreated, keratinization is possible);
• a significant increase in gum size, a change in its color to dark red (granulating course of hypertrophic gingivitis);
• severe compaction of gum tissue, the appearance of painful sensations on palpation (fibrous development).

Inflammatory processes in the oral area

In addition to generalized inflammation of the entire gingival surface, local processes are possible in certain areas due to the development of periodontitis, injury to the gums by the crown, and the eruption of wisdom teeth.

Also, inflammatory processes in the gums of pregnant women stand apart. We will talk about these situations.

Periodontitis

Fistula with periodontitis

A characteristic feature of periodontitis is the formation of a cyst at the apex of the root of the affected tooth in the form of a pus-filled sac, which causes swelling, swelling and soreness of the gums.

In this case, the swelling is fickle, appearing and disappearing.

The cause of the development of the disorder is advanced caries that has developed into pulpitis, or poor-quality filling of root canals during the treatment of pulpitis or at the stage of preparation for prosthetics.

An X-ray image, compared by a doctor with the results of a visual examination, allows making a final diagnosis and establishing periodontitis. In this situation, the image clearly shows a change in the bone tissue in the area of ​​the tooth root and poor quality of the filling.

Inflammatory process during pregnancy

Changes in the condition of the gums with the development of bleeding and swelling are very often observed during pregnancy.

The provoking factor, dentists call, is a change in a woman’s hormonal levels, which, with deterioration of oral hygiene, leads to the development of gum inflammation.

You need to be especially attentive to the condition of the oral cavity in the second and third trimesters (the hypertrophic process shown in the photo is typical for these periods).

In the absence of timely treatment, inflammation can quickly progress, not only aggravating the general condition of the expectant mother, but also provoking premature birth and the birth of underweight babies.

Prosthetics and installation of crowns

Incorrect prosthetics with the installation of crowns or dentures with overhanging edges cause permanent injury to the gums, which ultimately develops a large-scale inflammatory process.

In such a situation, a periodontal pocket of sufficiently deep depth can form in the interdental space, in which inflammation develops.

Negative effects of wisdom teeth

Cutting figure eights is one of the likely causes of inflammation of the gums, which swell and become painful in the tooth area.

The presence of slight swelling is considered normal, but if the inflammation becomes widespread, you should immediately consult a doctor due to the risk of wound infection.

The most common type of inflammation of the gums during the eruption of wisdom teeth is pericoronitis, which is associated with the entry of food particles under the gingival hood covering the molar and the development of pathogenic microorganisms there.

In this case, not only the gums around the tooth can become inflamed, but also neighboring tissues, which can lead to a purulent abscess.

You can cope with the disease only with the participation of a specialist who will prescribe appropriate therapy using antiseptic solutions for washing, rinsing or, if necessary, excise the hood that creates trouble or completely remove the wisdom tooth.

An integrated approach to treatment

It is necessary to begin treatment of the inflammatory process from the moment the first symptoms are detected. Therapy aimed at eliminating inflammation is quite multifaceted, so you can choose the most suitable method of treatment.

Consultation and initial examination of a specialist

First of all, the dentist visually assesses the condition of the oral cavity and the degree of the inflammatory process.

One of the first measures for such complaints is a complete sanitation of the mouth, which, as a rule, is followed by the removal of deposits on the teeth using a special ultrasonic device.

Sanitation of the oral cavity through the treatment of teeth affected by caries can eliminate the acute inflammatory process (in particular, alleviate the condition of necrotizing ulcerative gingivitis). Also, this measure is necessary to reduce the risk of re-development of inflammation.

Removing plaque from teeth makes it possible to eliminate one of the main causes of inflammation - exposure to pathogenic microorganisms.

After ultrasonic cleaning, the teeth are polished, creating a smooth surface on which plaque will not accumulate. If the gums are very inflamed and bleeding, polishing is carried out when the process becomes less acute.

Anti-inflammatory therapy

Anti-inflammatory treatment of gum inflammation is carried out using various medications: antiseptic solutions for rinsing from a syringe, therapeutic periodontal dressings and applications.

Depending on the cause of the inflammatory process, the following treatment methods are used:

If antibacterial therapy is required, then medications are selected from the group of macrolides (Sumamed, Azithromycin), cephalosporins (Ephodox, Cefazolin) and penicillins (Augmentin, Amoxiclav).

If hypertrophic gingivitis develops, surgical intervention may be required at the discretion of the dentist.

Antibiotics (in tablet form) are prescribed to all patients with necrotizing ulcerative gingivitis and for persistent acute gingivitis. The most commonly used medications are: Clindamycin, Ofloxacin, Augmentin, Azithromycin, Lincomycin.

The course of antibiotic therapy is chosen by the doctor individually.

Treatment regimen for gum inflammation at home

In addition to antibiotics, to relieve inflammation, irrigation of the oral cavity with Proposol aerosol and lubrication of the affected areas with dental ointments, such as Metrogyl or Solcoseryl, can be prescribed. The use of drugs in gel form is preferable, since its base promotes the absorption of the active substance into the gums.

To boost immunity, your doctor may prescribe vitamins - ascorbic acid or ascorutin. If desired, they can be replaced with rosehip infusion.

Tactics for action at home for inflammation and soreness of the gums are presented in the diagram.

Treatment of inflammation caused by injury

If the cause of the inflammatory process is injury to the gums by the overhanging edge of the filling, first of all, the offending area is cut down or the filling material is completely replaced.

If prosthetics fail, drug therapy similar to the treatment of gingivitis may first be prescribed, after which, depending on the result, the need to replace the crowns for a complete cure is considered.

Features of choosing toothpaste and brush

Inflammation of the gums requires an integrated approach to treatment, therefore, along with properly selected drug therapy, it is necessary to carefully consider the choice of toothbrush and toothpaste.

The paste should contain:

• anti-inflammatory components(extracts of ginseng, sage, chamomile, calendula, St. John's wort, cloves);
• antibacterial substances(having an effect on gram-negative and gram-positive bacteria - triclosan, used in conjunction with a copolymer that prolongs the action of the component);
• regenerating gum tissue products (oil solutions of vitamins A and E, carotoline, some enzymes).

It should be noted that toothpastes with antibacterial components are not intended for daily use due to the negative impact on the oral microflora in case of long-term use. Such pastes can be used for no longer than 3 weeks, after which it is necessary to take a 5-6 week break.

The only option that is suitable for daily use and has not only a therapeutic, but also a preventive effect, are toothpastes with a natural component such as tea tree oil.

A brush suitable for cleaning an inflamed oral cavity should be soft enough so that the mucous membrane and gums do not experience excessive pressure. You can use the brush for no longer than one month.

Preventive actions

Inflammation of the gums, especially in the acute stage, requires long-term and complex treatment, so you should remember about preventive measures that will significantly reduce the risk of developing such a disease and do not postpone a visit to the doctor if alarming symptoms appear.

If you want to improve the appearance of your smile, if you don’t like something about it, but you cannot accurately and correctly formulate what exactly, if you want to talk with your dentist about the aesthetics of your smile in the same language, then the following note is just right for you.

Nature (or God... depending on your views on life) has made us different. And our originality and uniqueness have its own charm. But what to do when this uniqueness goes too far beyond our ideas of beauty? How to formulate your claims to nature (and perhaps to the previous intervention of dentists)? To assess the aesthetic component of our face, lips, teeth - everything what gives birth to a beautiful harmonious smile It turns out there are a lot of parameters. This is what dentists use (at least should use) when planning changes in your appearance. Since there are very, very many different nuances, and I don’t have the task of making each of you expert in the field of aesthetic dentistry, then we will focus on the ten simplest and most important.

1. Parallelism of horizontal landmarks.

One of the most important signs of a harmonious smile is the parallelism of imaginary lines: the interpupillary line (in the picture there is a blue line connecting the right and left pupil of the eye) and the lip line (in the picture there is a red line drawn between the corners of the mouth).

Both of these lines should also be parallel to the lines connecting the edges of the central incisors (green) and the incisal cusps of the canines (blue)

2. Smile line.

The smile line runs along the cutting edges of the upper front teeth(shown in the photo with a solid line) and should ideally follow the curve of the upper edge of the lower lip (shown in the photo with a dotted line), i.e. be convex.

3. Gum level.

A smile looks more attractive and aesthetically pleasing, in which the line connecting the necks of the teeth (shown by a dotted line) repeats the line of the upper lip, and the level of the gum exposed when smiling is symmetrical on the right and left. At the same time, with a maximally open smile, only the gum “triangles” between the teeth and a small strip of gum above them (no more than 2-3 mm wide) should be noticeable.

Thus, the gums around the upper teeth, upper and lower lips form a kind of frame for your smile. If the “picture” is not visible behind the frame, then such a smile will not look attractive.

Excessive visualization of the gums (the so-called “gummy smile”) is most often eliminated with the help of surgery, orthodontic treatment, as well as cosmetic interventions (for example, Botox injections into the upper lip, upper lip augmentation, etc.).

4. Vertical symmetry and midline.

A line passing through the center of the face should pass exactly between the central incisors of the upper jaw. The discrepancy between these lines causes a feeling of disharmony even with a quick glance at your smile from the outside. In this case, it is not at all necessary that it also passes between the central lower incisors. Firstly, complete coincidence rarely occurs, and secondly, this in no way affects aesthetic perception of your smile when looking at it from the outside.

5. "Golden proportion".

The principle of the golden proportion in relation to the smile in aesthetic dentistry is that when looking at it from the front strictly in the center, the ratio of the visible width of the front teeth should be approximately the following - 0.6 (width of the canine): 1 (width of the lateral incisor): 1.6 (width of the central incisor).

As can be seen in the photo, the width of the visible part of the remaining teeth (4s, 5s) should consistently decrease, creating a sense of perspective.

6. Tooth proportions.

The central incisors of the upper jaw always attract special attention, because... best visible when talking and smiling. Therefore, it is very important that their proportions are correct. Teeth look most harmonious having a tooth width to length ratio of approximately 0.7-0.8: 1

However, at different ages this ratio may change. Due to the physiological wear of teeth in older age, this ratio tends to be 1:1. Therefore, if you want to “rejuvenate” your smile, you usually need to increase the length of the tooth.

7. Interincisal angles.

Interincisal angles are the spaces between the cutting edges of the anterior group of teeth.

With the harmonious construction of teeth, these angles should gradually increase from the center to the periphery: from a small closed angle between the central incisors, to a more direct and even open angle between the 2nd and 3rd teeth.

Tooth wear leads to a decrease or complete absence of interincisal angles, which makes the patient look older when he smiles.

At the same time, “female” teeth are characterized by rounded corners of the incisors, while “male” teeth are characterized by straighter ones.

8. Zenith of the gingival contour.

The zenith of the gum is its most concave part around the neck of the tooth (indicated by dots in the photo).

The level of zeniths near different teeth in the smile zone should be at different levels. For the central incisors and canines - approximately at the same level (or slightly higher for the canines), for the lateral incisors - slightly lower than both (as shown by the lines in the photo). At the same time, it is equally important that the zeniths on symmetrical teeth are at the same level. This is especially important to consider if this area becomes noticeable when smiling. When even with the most open smile the gums are not exposed, then there is no serious need to set the zeniths perfectly symmetrically.

In this case, attention is drawn to the too low zenith level on tooth 12; it is significantly lower than the symmetrical tooth 22. There is also a slight difference in the position of the zeniths on the central incisors (teeth 11 and 21). As a result of treatment, these shortcomings were eliminated, as can be seen in the first photo.

9. Position of cutting edges.

The cutting edges of the central group of teeth are also located at different levels. For the central incisors and canines - approximately at the same level, for the lateral incisors - slightly higher (as marked by lines in the photo).

Again, due to the abrasion of teeth with age, the cutting edges of the teeth become at the same level, the line connecting them takes on a straight rather than convex appearance, and sometimes (with increased pathological abrasion) even concave. Therefore, to make a smile more “youthful,” you need to return the relationship of the cutting edges to a harmonious one.

It can also be noted that the dominance of the central incisors over the lateral incisors and canines also gives the smile a more youthful appearance.

The dominance of the canines, their sharp, prominent cutting cusps, make the smile more aggressive. This effect is based on the fact that in nature, long, sharp, well-developed fangs are characteristic of predators, whose entire philosophy of existence is based on aggression towards their prey.

10. Interdental gingival papillae.

The gingival papilla is the part of the gum that fills the interdental space (marked with lines in the photo).

The location and appearance of the papillae is determined by the underlying bone, which has exactly the same contour. In the most optimal option, the tops of the gingival papillae are located as in the photo (marked with dots) - between the central incisors the gingival papilla is longest, and gradually its length decreases towards the periphery. Moreover, they should all have a healthy appearance - a triangular shape with a sharp apex, pink color, no swelling.

With various periodontal diseases, as well as with improperly performed restorations, the gingival papilla may become inflamed, acquiring a darker (or even bluish) color, losing its pointed shape, or may even disappear completely. At the same time, unaesthetic black spaces form between the teeth.

This is what the main, but still far from complete, list of parameters that need to be assessed and taken into account when planning and creating an ideal smile looks like. What he does aesthetic dentistry. Now you can evaluate for yourself how close your smile is to ideal. And I hope that this note will help you better understand what exactly you would like to change and improve. After all, this will greatly facilitate mutual understanding between you and your dentist.