Description

Gingivitis is a reversible form of inflammation of the gingiva. It is a mild form of periodontal disease. Classification includes:

• Plaque-induced
• Not plaque-induced (bacterial, viral, or fungal; e.g., acute necrotizing gingivitis, Vincent disease, denture-related)
• Modified by systemic factors (e.g., pregnancy, HIV, diabetes, leukemia)
• Modified by medications (antihypertensives, antipsychotics, antiepileptics, hormones)
• Modified by malnutrition (vitamin deficiencies)
• System(s) affected: Gastrointestinal; ENT; Dental
• Synonym(s): Mild periodontal disease; Gum disease

Geriatric Considerations
More frequent in this age group (due more to additive effects than to increased susceptibility)

Pediatric Considerations
Mild cases common in children (most common form of pediatric periodontal disease) and usually require no specific interventions

• Very common in pregnant women; hormonal effect
• Hyperplasia
• Common; self-limited

Epidemiology

• Predominant age: >35 years (but as young as 5)
• Predominant sex: Male = Female

• ~50% of children
• ~90% of adolescents and adult population
• ~30–75% of pregnant women

Risk Factors

• Poor dental hygiene/plaque formation
• Pregnancy
• Uncontrolled diabetes mellitus
• Malocclusion or dental crowding
• Smoking
• Mouth breathing
• Faulty dental restoration
• HIV-positive; AIDS
• Stress
• Hospitalization (1)
• Vitamin C deficiency; coenzyme Q10 deficiency
• Dental appliances (dentures, braces)
• Eruption of primary or secondary teeth
• Necrotizing ulcerative gingivitis:
  • Stress
  • Lack of sleep
  • Malnutrition
  • Viral illness
  • Typically younger patients/teens and young adults
• Bronchial asthma (2)
• Rheumatoid arthritis (3)

Genetics
Possible genetic link (up to 30% of population). Rare condition called hereditary gingival fibromatosis associated with hirsutism

General Prevention

• Good oral hygiene:
  • Adults:
    • Regular twice-daily brushing with fluoride toothpaste and increased benefit of using circular oscillating electric brush rather than regular brush (4)[A]
    • Daily “high-quality” flossing (many studies show that flossing does not help because it is often done incorrectly) (5)[A]
  • Pediatrics:
    • Regular twice-daily brushing with fluoride toothpaste under parental supervision until full manual dexterity (~8 years of age)
    • Regular flossing if no spaces between teeth
• Cleaning by a dentist or hygienist every 6 months or more frequently, if indicated
• Mouthrinse with essential oils (menthol, thymol, eucalyptol; e.g., Listerine) combined with brushing reduces gingivitis more than brushing alone (6). Caution: Long-term use of alcohol-based mouthrinse may be associated with an increase risk of oral cancer (7)[A].

Pathophysiology

Inflammation of gingiva. This can progress to deeper, destructive inflammation (see “Periodontitis”)

Etiology

• Usually noncontagious
• Inadequate plaque removal
• Blood dyscrasias (pregnancy)
• Oral contraceptives
• Allergic reactions
• Nutritional deficiencies
• Vasoconstriction (nicotine, metamphetamine)
• Endocrine/Hormonal variations:
  • Pregnancy
  • Menses
  • Menarche
• Chronic debilitating disease
• Vincent disease:
  • Synergistic infection with fusiform bacillus (Fusobacterium spp.) and spirochete (Borrelia vincentii)

Commonly Associated Conditions

• Periodontitis
• Glossitis
• Pedunculated growths (pyogenic granulomata)