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Gingivitis (“inflammation of the gum tissue”) is a non-destructive periodontal disease. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) adherent to tooth surfaces, termed plaque-induced gingivitis. Gingivitis is reversible with good oral hygiene. However, in the absence of treatment, or if not controlled, gingivitis can progress to periodontitis, where the inflammation results in tissue destruction and alveolar bone resorption, which can ultimately lead to tooth loss.
While in some sites or individuals gingivitis never progresses to periodontitis, data indicate that periodontitis is always preceded by gingivitis.
The symptoms of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation:
- Swollen gums
- Bright red or purple gums
- Gums that are tender or painful to the touch
- Bleeding gums or bleeding after brushing and/or flossing
- Bad breath (halitosis)
Additionally, the stippling that normally exists on the gum tissue of some individuals will often disappear and the gums may appear shiny when the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. The accumulation may also emit an unpleasant odor. When the gingiva are swollen, the epithelial lining of the gingival crevice becomes ulcerated and the gums will bleed more easily with even gentle brushing, and especially when flossing.
Risk factors associated with gingivitis are:
- low dental care utilization
- poor oral hygiene levels
- psychosocial stress and genetic factors
- pre-existing conditions
ecause plaque-induced gingivitis is by far the most common form of gingival diseases, the following sections will deal primarily with this condition.
The etiology, or cause, of plaque-induced gingivitis is bacterial plaque, which acts to initiate the body’s host response. This, in turn, can lead to destruction of the gingival tissues, which may progress to destruction of the periodontal attachment apparatus. The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that serve to accumulate and maintain plaque. Examples of plaque traps include bulky and overhanging restorative margins, claps of removable partial dentures and calculus (tartar) that forms on teeth. Although these accumulations may be tiny, the bacteria in them produce chemicals, such as degrative enzymes, and toxins, such as lipopolysaccharide (LPS, otherwise known as endotoxin) or lipoteichoic acid (LTA), that promote an inflammatory response in the gum tissue. This inflammation can cause an enlargement of the gingiva and subsequent formation. Early plaque in health consists of a relatively simple bacterial community dominated by Gram-positive cocci and rods. As plaque matures, and gingivitis develops, the communities become increasingly complex with higher proportions of Gram-negative rods, fusiforms, filaments, spirilla and spirochetes. Later experimental gingivitis studies, using culture, provided more information regarding the specific bacterial species present in plaque. Taxa associated with gingivitis included Fusobacteriumnucleatum subsp. polymorphum, Lachnospiraceae [G-2] sp. HOT100, Lautropia sp. HOTA94, and Prevotellaoulorum, whilst Rothiadentocariosa was associated with periodontal health. Further study of these taxa is warranted and may lead to new therapeutic approaches to prevent periodontal disease.
The structure of this template
Gingivitis is a category of periodontal disease where there is no loss of bone but there is presence of inflammation and bleeding.
Each tooth is divided into four gingival units (mesial, distal, buccal, and lingual) and given a score from 0-3 based on the gingival index. The four scores are then averaged to give each tooth a single score. The diagnosis of the periodontal disease gingivitis is done by a dentist. The diagnosis is based on clinical assessment data acquired during a comprehensive periodontal exam Either a registered dental hygienist or a dentist may perform the comprehensive periodontal exam but the data interpretation and diagnosis is done by the dentist. The comprehensive periodontal exam consists of a visual exam, a series of radiographs, probing of the gingiva, determining the extent of current or past damage to the periodontium and a comprehensive review of the medical and dental histories.
Current research shows that activity levels of the following enzymes in saliva samples are associated with periodontal destruction: asparatate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), alkaline phosphatase (ALP), and acid phosphatase (ACP). Therefore these enzyme biomarkers may be used to aid in the diagnosis and treatment of gingivitis and periodontitis.
A dental hygienist or dentist will check for the symptoms of gingivitis, and may also examine the amount of plaque in the oral cavity. A dental hygienist or dentist will also look for signs of periodontitis using X-rays or periodontal probing as well as other methods.
If gingivitis is not responsive to treatment, referral to a periodontist (a specialist in diseases of the gingiva and bone around teeth and dental implants) for further treatment may be necessary.
As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary categories of gingival diseases, each with numerous subgroups:
1. Dental plaque-induced gingival diseases.
- Gingivitis associated with plaque only
- Gingival diseases modified by systemic factors
- Gingival diseases modified by medications
- Gingival diseases modified by malnutrition
2. Non-plaque-induced gingival lesions
- Gingival diseases of specific bacterial origin
- Gingival diseases of viral origin
- Gingival diseases of fungal origin
- Gingival diseases of genetic origin
- Gingival manifestations of systemic conditions
- Traumatic lesions
- Foreign body reactions
- Not otherwise specified
Gingivitis before (top) and after (bottom) a thorough mechanical debridement of the teeth.
Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes may also be employed. In a 2004 clinical study, the beneficial effect of hydrogen peroxide on gingivitis has been highlighted.
Rigorous plaque control programs along with periodontal scaling and curettage also have proved to be helpful, although according to the American Dental Association,periodontal scaling and root planing are considered as a treatment for periodontal disease, not as a preventive treatment for periodontal disease. In a 1997 review of effectiveness of data .
The focus of treatment is to remove plaque. Therapy is aimed at the reduction of oral bacteria, and may take the form of regular periodic visits to a dental professional together with adequate oral hygiene home care. Thus, several of the methods used in the prevention of gingivitis can also be used for the treatment of manifest gingivitis, such as scaling, root planing, curettage, mouth washes containingchlorhexidine or hydrogen peroxide, and flossing. Interdental brushes also help remove any causative agents.
Powered toothbrushes work better than manual toothbrushes in improving the disease.
The active ingredients approved by the American Dental Association that “reduce plaque and demonstrate effective reduction of gingival inflammation over a period of time” are triclosan, chlorhexidinedigluconate, and a combination of thymol, menthol, eucalyptol and methyl salicylate. These ingredients are found in toothpaste and mouthwash. Hydrogen peroxide was long considered a suitable over-the-counter agent to treat gingivitis.
There has been evidence to show the positive effect on controlling gingivitis in short-term use. A study indicates the fluoridated hydrogen peroxide-based mouth rinse can remove teeth stain and reduce gingivitis.
Mouthwashes with essential oils are also useful.
The bacteria that causes gingivitis can be controlled by using an oral irrigator daily with a mouthwash containing an antibiotic. Eitheramoxicillin, cephalexin, or minocycline in 16 ounces of a non-alcoholic fluoride mouthwash is an effective mixture.
Overall, intensive oral hygiene care has been shown to improve gingival health in individuals with well-controlled type 2 diabetes.Periodontal destruction is also slowed down due to the extensive oral care.
Intensive oral hygiene care (oral health education plus supra-gingival scaling) without any periodontal therapy improves gingival health, and may prevent progression of gingivitis in well-controlled diabetes.
- Tooth loss, or decay
- Recurrence of gingivitis
- Infection or abscess of the gingiva or the jaw bones
- Trench mouth (bacterial infection and ulceration of the gums)
- Swollen glands
Gingivitis is a bacterial infection of the gums. The exact reason why gingivitis develops has not been proven, but several theories exist.
For gingivitis to develop, plaque must accumulate in the areas between the teeth. This plaque contains large numbers of bacteria thought to be responsible for gingivitis. But it is not simply plaque that causes gingivitis. Almost everyone has plaque on their teeth, but gingivitis is far less common.
It is usually necessary for the person to have an underlying illness or take a particular medication that renders their immune system susceptible to gingivitis. For example, people with diabetes, Addison’s disease, HIV, and other immune system diseases have weaker ability to fight bacteria invading the gums. People with Sjögren’s syndrome have chronic dryness of the mouth that predisposes them to develop gingivitis.
Sometimes hormonal changes in the body during pregnancy, puberty, and steroid therapy leave the gums vulnerable to bacterial infection.
A number of medications used for seizures, high blood pressure, and organ transplants can suppress the immune system and change the structure of the gums enough to permit bacterial
What is gum disease (gingivitis)?
Gum disease, or gingivitis, is inflammation of the tissues surrounding and supporting the teeth and is most commonly a result of poor dental hygiene. Gingivitis is a very common condition and varies widely in severity. It is characterized by red, swollen gums that bleed easily when teeth are brushed or flossed. Gingivitis is not the same thing as periodontitis, although sometimes a person may be affected by both.
What causes gum disease?
Gum disease is mostly caused by improper oral hygiene that allows bacteria in plaque and calculus to remain on the teeth and infect the gums. But there are other factors that increase the risk of developing gingivitis. Some of the most common risk factors are as follows:
- Smoking or chewing tobacco prevents the gum tissue from being able to heal.
- Crooked, rotated, or overlapping teeth create more areas for plaque and calculus to accumulate and are harder to keep clean.
- Hormonal changes in puberty, pregnancy, and menopause typically correlate with a rise in gingivitis. The increase in hormones causes the blood vessels in the gums to be more susceptible to bacterial and chemical attack.
- Cancer and cancer treatment can make a person more susceptible to infection and increase the risk of gum disease.
- Stress impairs the body’s immune response to bacterial invasion.
Does gum disease cause bad breath?
Bad breath, or halitosis, is most frequently associated with a condition of the mouth like gum disease. As the bacteria that are normally present in the mouth break down plaque and tartar, they release chemicals that have a strong odor. Bad breath can also come from plaque that builds up on the tongue. As the plaque and tartar are removed from the teeth and tongue with regular brushing, flossing, and professional dental cleanings, the halitosis can be eliminated. This is the easiest way to reverse bad breath, but it can take a while for the mouth odor to completely disappear. A person needs to be consistent and persistent with oral hygiene to reverse the condition.
Other causes of bad breath include partially erupted wisdom teeth, dry mouth, mouth breathing, postnasal drip, infections in the throat or lungs, tonsil stones, smoking, digestive problems, and systemic diseases like diabetes.
Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of bacteria that accumulate on the teeth – plaque; this type is called plaque-induced gingivitis. Gingivitis is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress toperiodontitis, which is more serious and can eventually lead to loss of teeth.
There are two main categories of gingival diseases (1999 World Workshop in Clinical Periodontics):
Dental plaque-induced gingival disease
- Gingivitis caused only by plaque
- Gingivitis caused by systemic factors
- Gingivitis caused by medications
- Gingivitis caused by malnutrition
Non-plaque induced gingival lesions
- Gingival diseases – caused by a specific bacterium
- Gingival diseases – caused by a specific virus
- Gingival diseases – caused by a specific fungus
- Gingival diseases – caused by genetic factors
- Gum inflammations caused by systemic conditions
- Gum inflammations caused by traumatic lesions
- Gum inflammations caused by reactions to foreign bodies
- Gum inflammations without known causes
What are the signs and symptoms of gingivitis?
A symptom is something the patient feels and describes, such as painful gums, while a sign is something everybody, including the doctor or nurse can see, such as swelling.
In mild cases of gingivitis there may be no discomfort or noticeable symptoms.
Signs and symptoms of gingivitis may include:
- Gums are bright red or purple
- Gums are tender, and sometimes painful to the touch
- Gums bleed easily when brushing teeth or flossing
- Halitosis (bad breath)
The accumulation of plaque and tartar
The most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth, which triggers animmune response, which in turn can eventually lead to the destruction of gingival tissue, and eventually further complications, including the loss of teeth.
Dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonizing bacteria that are trying to stick to the smooth surface of a tooth. Some experts say that they might help protect the mouth from the colonization of harmful microorganisms. However, dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis.
When plaque is not removed adequately, it causes an accumulation of calculus (tartar – it has a yellow color) at the base of the teeth, near the gums. Calculus is harder to remove, and can only be removed professionally.
Plaque and tartar eventually irritate the gums.
Gingivitis may also have other causes, including:
- Changes in hormones – which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva may become more sensitive, raising the risk of inflammation.
- Some diseases – such as cancer, diabetes, and HIV are linked to a higher risk of developing gingivitis.
- Drugs – oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin (anticonvulsant), and some anti-angina medications may also cause abnormal growth of gum tissue.
- Smoking – regular smokers more commonly develop gingivitis compared to non-smokers.
- Family history – experts say that people whose parent(s) has/had gingivitis, have a higher risk of developing it themselves.
A dentist or oral hygienist checks for gingivitis symptoms, such as plaque and tartar in the oral cavity.
Checking for signs of periodontitis may also be recommended; this may be done by X-ray or periodontal probing diseases, including heart attack or stroke. Other reports have found an association with lung disease risk.
What are the treatment options for gingivitis?
If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.
Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home.
Gingivitis care with a dental professional:
- Plaque and tartar are removed. This is known as scaling. Some patients may find scaling uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
- The dental professional explains to the patient the importance of oral hygiene, and how to effectively brush his/her teeth, as well as flossing
- Periodically following-up on the patient, with further cleaning if necessary
- Fixing teeth so that oral hygiene can be done effectively. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar (they may also irritate the gums).
What the patient can do at home:
- Brush your teeth at least twice a day
- Bear in mind that in most cases, electric toothbrushes do a better job than we can do on our own
- Floss your teeth at least once a day
What are the possible complications from gingivitis?
In the vast majority of cases, if gingivitis is treated and the patient follows the dental health professional’s instructions, there are no complications. However, if the condition is left untreated, gum disease can spread and affect tissue, teeth and bones, leading to periodontitis.
Possible complications from gingivitis may include:
- Abscess in the gingiva
- Abscess in the jaw bones
- Infection in the jaw bone or gingiva