Gingivitis is inflammation of the gingival or gum tissue caused by an accumulation of a bacterial biofilm or plaque present on tooth surfaces. It is generally caused by poor oral hygiene. Gingival inflammation occurs because the accumulated bacteria cause a tissue reaction (gum swelling), which is a way for our bodies to fight back against invading microorganisms. Gingivitis can also be caused by calcified bacterial plaque. Other possible causes of gingivitis are:

-Unpolished filling, which extends under the gum tissue

-A dental filling that has an open margin (gap between a tooth and a filling)

Gingivitis is the first stage and reversible form of gum disease. Longstanding inflammation of the gum tissue will eventually lead to soft tissue destruction by our bodies defense systems, and cause further destruction of soft and hard tooth supporting structures, also know as periodontitis or periodontal disease.

Clinical features of gingivitis may be characterized by the presence of any of the following clinical signs: redness and sponginess of the gingival (gum) tissue, bleeding on provocation, changes in contour of the gingiva, and presence of calculus (tartar) or plaque with no radiographic evidence of bone loss.

Gingivitis can occur with sudden onset and short duration and can be painful. A less severe phase of this condition can also occur.

Recurrent gingivitis reappears after having been eliminated by treatment or disappearing spontaneously.

Chronic gingivitis is slow in onset and of long duration and is the most common form encountered. It is painless unless complicated by acute exacerbations. Chronic gingivitis is a fluctuating disease in which inflammation persists or resolves and normal areas become inflamed.

Chronic gingivitis can be eliminated by good oral hygiene practice, professional dental cleaning

usually at six month intervals and use of certain mouthwash.

 

There are several types of gingivitis. These include:

Acute Necrotizing Gingivitis

Allergic Gingivitis

Desquamative Gingivitis

Gingivitis associated with diabetes mellitus

Neutropenia Gingivitis

Pregnancy Gingivitis

 

Acute Necrotizing Ulcerating Gingivitis (ANUG)

This form of gingivitis causes soreness and pain localized at the gingival (gum tissue) margin. Profuse gingival bleeding is very common. In the early stages some patients may complain of a feeling of tightness around the teeth. A metallic taste is sometimes experienced and usually there is halitosis or bad breath. Fever and malaise are sometimes present. Examination shows necrosis and ulceration of the gum tissue with different degrees of gum gingival (gum tissue) destruction. The presence of this condition is thought to be due to opportunistic infection with a mixture of organisms, especially spirochetes, fusiform bacilli and rods. It occurs in individuals predisposed by smoking, poor oral hygiene, or a medically compromised state. It occurs chronically in HIV infected individuals.

Treatment includes a full mouth dental cleaning done by a dentist or a hygienist. It is very important to stress the importance of good oral hygiene in elimination of the disease and prevention of future outbreaks. Antibiotics are often prescribed to aid in the elimination of the infection.

 

Allergic Gingivitis

Allergic gingivitis also known as plasma cell gingivitis is most commonly due to toothpaste allergy, particularly to the more modern tartar control formulations. Changing to a non-allergic toothpaste or use of baking soda to brush teeth can help in determine if a possible toothpaste allergy exists. If this modification fails to provide any clues, patch testing may be warranted.

 

Desquamative Gingivitis

Desquamative gingivitis is a clinical diagnosis with features of full-thickness gingivitis associated with desquamation of the attached gingiva. Attached gingiva refers to the portion of the tissue that is firmly attached to the bone and is not movable. Desquamative gingivitis can occur due to a variety of disorders, the most common being lichen planus. The most common complaints with desquamative gingivitis are bleeding on brushing and gingival (gum) tenderness. Diagnosis of the underlying cause requires biopsy.

 

Gingivitis associated with diabetes mellitus

The chief aspects of diabetes mellitus relevant to oral health care management are

Susceptibility to infection

Hypoglycemic coma

Diabetic coma

Ischemic heart disease

Diabetics who are unable to control their sugar levels are highly susceptible to infections. Poor oral hygiene and irregular professional dental cleanings predisposes diabetics to severe gingivitis and periodontitis within a short amount of time. Gingivitis will be more severe in a diabetic due to poor immune response caused by irregularities in blood sugar levels. Excellent oral hygiene, regular dental cleanings at intervals between 3-6 months and good control of blood sugar levels can maintain good oral health.

 

Neutropenia Gingivitis

Neutropenia is a disorder characterized by an abnormally low number of neutrophils, white blood cell responsible for primary defense against infections. Neutropenia is an important cause of oral ulceration and gingivitis and is often associated with bacterial infection, particularly pharyngitis. Neutropenia is usually seen secondary to drug therapy, and is an important reason for stopping the drugs when it occurs in consultation with the patient’s physician. Neutropenia can be diagnosed by doing a differential white blood cell count as part of FBC or full blood count.

 

Pregnancy Gingivitis

Pregnancy gingivitis is characterized by soft, reddish, enlargements usually of the gingival located between the teeth. The lumps vary from small smooth enlargements to more extensive, ragged, granular lumps, which sometimes resemble the surface of a strawberry. A similar appearance may complicate the use of oral contraceptives. Poor oral hygiene predisposes to these changes. Changes of pregnancy gingivitis usually appear about the second month of pregnancy and reach a peak at the eight month. The changes may revert soon after parturition to the previous level of gingival health. The chief concern is usually gingival bleeding during eating or brushing teeth. Professional cleaning and improvement in oral hygiene practice usually improves the condition.

 

There are other forms of gingivitis and gingival enlargement conditions not mentioned here. These forms range from gingivitis caused by mouth breathing to a much more severe cases of gingival inflammation and swelling which can be a manifestation of leukemia or other forms of cancer. It is always a good idea to have your dentist examine the inflamed gum tissue to rule out more serious conditions.

End tufted brush or a specialty toothbrush is a great tool for getting into spaces that are too wide for floss. With a small brush one can easily clean around braces, crowns and implants. Gentle massaging of the gum will simulate and firm the gum tissue making it less prone to bleeding. It is also recommended for cleaning hard to reach areas like the back of a wisdom tooth.

Gum stimulator is used to stimulate the gum tissue, which strengthens it and makes it more firm.

Has been proven to fight gingivitis as well as periodontal disease. Excellent tool for individuals who brush and floss daily and still have problem areas.