Chronic catarrhal gingivitis

Symptoms and Diagnosis of Chronic Catarrhal Gingivitis

Clinical Presentation and Patient Complaints

The clinical picture of chronic catarrhal gingivitis is generally quite typical, and establishing the diagnosis usually does not cause significant difficulties for a dental professional. Patients with chronic catarrhal gingivitis commonly complain of:

• Gingival Bleeding: This is a hallmark symptom, often noticed during mechanical irritation such as brushing teeth, flossing, or eating hard or coarse food.
• Slight Itching or Discomfort in the Gums: Some patients may report a mild itching, burning, or generally uncomfortable sensation in their gums.
• Redness and Swelling: Gums may appear redder than normal (hyperemia) and slightly swollen or puffy, particularly along the margins and interdental papillae. The normal stippled (orange-peel) appearance of healthy gingiva may be lost.
• Bad Breath (Halitosis): May be present due to bacterial activity and inflammation.

From the patient's anamnesis (medical history), it can often be determined that the disease began gradually and was practically asymptomatic or caused minimal noticeable symptoms for a long period. It should be borne in mind that chronic catarrhal gingivitis most frequently develops in children, adolescents, and young adults (up to approximately 25-30 years of age), though it can occur at any age if oral hygiene is suboptimal.

The general systemic condition of the patient with uncomplicated chronic catarrhal gingivitis is typically not disturbed; fever and malaise are usually absent.

Diagnostic Evaluation and Differential Diagnosis

Examination of the oral cavity by a dentist or periodontist reveals characteristic signs:

• Dental Plaque and Calculus: Non-mineralized supragingival dental plaque is usually evident, and varying amounts of calculus ("tartar") may also be present.
• Gingival Inflammation: The gums exhibit signs of chronic mild inflammation, including edema (swelling), bleeding on probing (BOP), and hyperemia (redness). The consistency of the gingiva may be softer or more boggy than firm, healthy gums.
• Absence of Clinical Pockets: A key feature distinguishing gingivitis from periodontitis is the absence of true periodontal pockets. While there might be "pseudopockets" due to gingival swelling, there is no apical migration of the junctional epithelium or loss of connective tissue attachment.
• No Tooth Mobility or Displacement: In uncomplicated gingivitis, the teeth are typically firm and not displaced.
• Radiographic Findings: X-ray examination (e.g., bitewings, periapical radiographs) in chronic catarrhal gingivitis will generally not show any changes in the bone tissue of the interdental septa or other parts of the jawbones. The alveolar crest should appear intact.

To diagnose chronic catarrhal gingivitis and monitor the effectiveness of treatment, the following are usually sufficient:

• Patient history and inquiry about symptoms and oral hygiene habits.
• Clinical examination of the oral cavity and gums.
• Assessment and scoring of dental plaque levels (e.g., Plaque Index).
• Probing for bleeding (Bleeding on Probing Index).
• Schiller-Pisarev test (iodine test for glycogen content, indicating inflammation - less commonly used in modern routine practice but historically noted).

For differential diagnosis between chronic catarrhal gingivitis and early periodontitis, careful probing of the gingival sulcus to detect any true clinical pocket formation (attachment loss) is essential. Assessment of tooth mobility and, in doubtful cases, radiographic examination of the alveolar processes of the jaws are indicated to rule out bone loss characteristic of periodontitis.

Treatment of Chronic Catarrhal Gingivitis

The treatment of chronic catarrhal gingivitis is primarily aimed at controlling and eliminating dental plaque, reducing gingival inflammation, and restoring gingival health. It is a reversible condition with appropriate intervention.

Initial Phase: Professional Oral Hygiene and Antiseptic Treatment

1. Antiseptic Mouth Rinses/Oral Baths: Treatment often begins with antiseptic treatment of the oral cavity to reduce the bacterial load. Solutions commonly used include:
   • Hydrogen peroxide: 1% solution (diluted from 3%).
   • Chlorhexidine gluconate: 0.12% or 0.06% solution.
   • Furacilin (nitrofurazone): 0.02% solution (historical use).
   Antiseptics for chronic catarrhal gingivitis can be used in the form of oral baths (holding the solution in the mouth for a period), rinses, or direct applications to the gums.
2. Removal of Dental Deposits (Professional Cleaning): This is the most important stage of treatment. It involves:
   • Covering separate groups of teeth with cotton rolls for isolation.
   • Using special dental instruments (e.g., scalers, curettes, ultrasonic devices, hooks, excavators) to carefully remove all "tartar" (calculus) and soft "dental" plaque from tooth surfaces, both supragingivally and slightly subgingivally.
   • Polishing the tooth surfaces with special brushes and abrasive prophylactic pastes to create a smooth surface that is less prone to plaque accumulation.
3. Post-Cleaning Antiseptic Treatment: After "professional teeth cleaning," antiseptic treatment of the oral cavity (e.g., with chlorhexidine rinse) is often repeated.

The removal of dental deposits is typically carried out over 1-2 dental visits, depending on the amount of plaque and calculus present.

Patient Education and Oral Hygiene Instruction

A defining and crucial component in the successful treatment and long-term prevention of chronic catarrhal gingivitis is establishing and maintaining effective personal oral hygiene. This involves:

• Education on Plaque Control: During the first visit, the dental professional should thoroughly discuss with the patient the role of plaque in causing gingivitis and the rules for effective tooth brushing.
• Toothbrush and Toothpaste Recommendations: Guidance on choosing an appropriate toothbrush (e.g., soft bristles, correct size) and toothpaste (e.g., with fluoride).
• Interdental Cleaning Instruction: Teaching the proper use of dental floss, interdental brushes, or other aids to clean between teeth where a toothbrush cannot reach.
• Monitoring Effectiveness: During follow-up visits, the effectiveness of the patient's home care measures is monitored, often by using disclosing solutions or tablets to stain dental plaque, making it visible and allowing for targeted feedback and reinforcement of techniques.

Pharmacological Interventions for Inflammation

In the presence of severe gingival inflammation in chronic catarrhal gingivitis, adjunctive anti-inflammatory or antimicrobial agents may be applied or prescribed:

• Topical Anti-inflammatory/Antimicrobial Agents: Gels or rinses containing chlorhexidine, triclosan, or essential oils.
• Systemic Anti-inflammatory Drugs (Rare for uncomplicated gingivitis): In cases with very pronounced inflammation, short courses of NSAIDs (e.g., acetylsalicylic acid - aspirin, butadione - phenylbutazone, indomethacin - all historical mentions with significant side effect profiles; modern safer NSAIDs like ibuprofen would be preferred if systemic anti-inflammatories were deemed necessary, though topical management is primary).
• Systemic Antimicrobial Agents (Rare for uncomplicated gingivitis): In severe or refractory cases, or if there are signs of more aggressive disease, oral administration of antibiotics like metronidazole or lincomycin might be considered, but this is generally not standard for simple chronic catarrhal gingivitis and is more relevant for specific forms of gingivitis or periodontitis.

Physiotherapeutic Procedures (Adjunctive)

A good therapeutic effect in the treatment of chronic catarrhal gingivitis can sometimes be achieved by the adjunctive use of physiotherapeutic procedures, selected based on their therapeutic actions:

• Hydromassage of Gums: Using an oral irrigator or specialized device can help remove soft plaque and improve microcirculation in the gingival tissues.
• Ultraviolet (UV) Irradiation on the Gum Area: Aimed at providing an antibacterial effect (less common in modern practice).
• Anode-Galvanization or Iontophoresis of Medicinal Substances: Using an electrical current to enhance the penetration of substances like calcium chloride or vitamin B1 into the tissues (from the anode).
• UHF (Ultra-High Frequency) Therapy in an Oligothermic Dose: To reduce inflammation.
• Local Hypothermia (Cryotherapy): Application of cold to reduce inflammation and bleeding.
• Helium-Neon Laser Radiation (Low-Level Laser Therapy - LLLT): To promote healing and reduce inflammation.
• Plasma Flow of Argon (e.g., Argon Plasma Coagulation - used for hemostasis/ablation, less for simple gingivitis inflammation): Aimed at an anti-inflammatory effect, normalization of tissue trophism, and microcirculation.

The role and efficacy of many physiotherapeutic modalities require further robust evidence in the context of modern periodontal care, with professional plaque removal and optimal patient oral hygiene remaining the cornerstones of treatment.

Distinguishing Chronic Catarrhal Gingivitis from Other Gingival Conditions

It is important to differentiate chronic catarrhal gingivitis from other gingival and periodontal diseases:

Complications and Prevention

The primary complication of untreated chronic catarrhal gingivitis is its progression to **chronic periodontitis**. This involves the destruction of the periodontal ligament and alveolar bone that support the teeth, leading to periodontal pocket formation, tooth mobility, and eventual tooth loss. Therefore, early detection and treatment of gingivitis are crucial.

Prevention focuses on:

• Effective Daily Oral Hygiene: Thorough tooth brushing twice a day with fluoride toothpaste and daily interdental cleaning (flossing or interdental brushes) to remove plaque.
• Regular Professional Dental Care: Routine dental check-ups and professional cleanings (scaling and polishing) to remove plaque and calculus that cannot be removed by home care alone. Frequency depends on individual risk.
• Healthy Diet: Limiting sugary and sticky foods that contribute to plaque formation.
• Avoiding Tobacco Products: Smoking is a major risk factor for periodontal diseases.

When to Seek Dental Care

Individuals should seek professional dental care if they notice any of the following signs of gingivitis:

• Gums that bleed easily (e.g., during brushing or eating).
• Red, swollen, or tender gums.
• Persistent bad breath or a bad taste in the mouth.
• Gums that have pulled away from the teeth (though this is more indicative of periodontitis).

Regular dental visits allow for early detection and management of gingivitis before it progresses to more severe periodontal disease.