Gingivitis
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Basics
Description
Gingivitis is a reversible form of inflammation of the gingiva. It is a mild form of periodontal disease. Classification includes the following:
- Plaque induced
- Not plaque induced (bacterial, viral, or fungal; e.g., necrotizing ulcerative gingivitis, Vincent disease [“trench mouth”], denture related)
- Modified by systemic factors (e.g., pregnancy, puberty, HIV, diabetes, smoking, leukemia)
- Modified by medications (calcium channel blockers, antipsychotics, antiepileptics, antirejection medications, hormones)
- Modified by malnutrition (vitamin deficiencies)
- Acute or chronic
- System(s) affected: gastrointestinal; ears, nose, throat; 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
Cases of plaque-induced gingivitis are common in children (most common form of pediatric periodontal disease) and usually require no specific interventions other than improved oral hygiene.
Pregnancy Considerations
- Very common in pregnant women; hormonal effect
- Self-limited
Epidemiology
- Predominant age: children, teenagers, and young adults
- Predominant sex: slightly more males than female
- Prevalence ~50% of children
- ~90% of adolescents and adult population
- ~30–75% of pregnant women
- 42% of adults in United States have periodontal diseases (1).
Etiology and Pathophysiology
Inflammation of the marginal gingiva. This can progress to deeper, destructive inflammation; if involving supporting bone, will be classified as periodontitis, not gingivitis (2)
- Usually noncontagious
- Inadequate plaque removal
- Blood dyscrasias (pregnancy)
- Medication induced (e.g., oral contraceptives, antiepileptics)
- Allergic reactions
- Nutritional deficiencies
- Vasoconstriction (nicotine, methamphetamine)
- Endocrine/hormonal variations
- Pregnancy, menses, menarche
- Chronic debilitating disease
- Vincent disease, necrotizing ulcerative gingivitis
- Synergistic infection with fusiform bacillus (Fusobacterium spp.) and spirochete (Borrelia vincentii)
- Pathology
- Acute or chronic inflammation
- Hyperemic capillaries
- Polymorphonuclear infiltration
- Papillary projections in subepithelial tissue
- Fibroblasts
Genetics
Possible genetic link (up to 30% of population); rare condition called hereditary gingival fibromatosis, where severe gingival hyperplasia covers teeth, associated with hirsutism
Risk Factors
- Poor dental hygiene/plaque formation
- Pregnancy
- Uncontrolled diabetes mellitus
- Malocclusion or dental crowding
- Smoking
- Mouth breathing
- Xerostomia
- Faulty dental restorations
- HIV-positive; AIDS
- Stress
- Hospitalization
- 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 teens and young adults
- Bronchial asthma and other respiratory diseases
- Rheumatoid arthritis
- Epilepsy
General Prevention
- Good oral hygiene
- Adults
- Regular twice-daily brushing with fluoride toothpaste
- May be increased benefit of using circular oscillating electric brush rather than regular brush or sonic/vibration, although evidence is inconclusive (2,3)
- Daily “high-quality” flossing (studies show that flossing only helps when it is done correctly) and interdental brushes (2,4)
- Chlorhexidine with oral hygiene better than other oral rinse agents (2,5)
- Use in acute phase (2).
- 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
- Adults
- Cleaning by a dentist or hygienist every 6 months or more frequently, as indicated (2)
- Mouth rinse with essential oils (menthol, thymol, eucalyptol; e.g., Listerine) combined with brushing (2)
- It had been thought that long-term use of alcohol-based mouth rinse may be associated with an increased risk of oral cancer. A recent systematic review found no evidence (2).
Commonly Associated Conditions
- Periodontitis
- Glossitis
- Pedunculated growths (pyogenic granulomata)
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Basics
Description
Gingivitis is a reversible form of inflammation of the gingiva. It is a mild form of periodontal disease. Classification includes the following:
- Plaque induced
- Not plaque induced (bacterial, viral, or fungal; e.g., necrotizing ulcerative gingivitis, Vincent disease [“trench mouth”], denture related)
- Modified by systemic factors (e.g., pregnancy, puberty, HIV, diabetes, smoking, leukemia)
- Modified by medications (calcium channel blockers, antipsychotics, antiepileptics, antirejection medications, hormones)
- Modified by malnutrition (vitamin deficiencies)
- Acute or chronic
- System(s) affected: gastrointestinal; ears, nose, throat; 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
Cases of plaque-induced gingivitis are common in children (most common form of pediatric periodontal disease) and usually require no specific interventions other than improved oral hygiene.
Pregnancy Considerations
- Very common in pregnant women; hormonal effect
- Self-limited
Epidemiology
- Predominant age: children, teenagers, and young adults
- Predominant sex: slightly more males than female
- Prevalence ~50% of children
- ~90% of adolescents and adult population
- ~30–75% of pregnant women
- 42% of adults in United States have periodontal diseases (1).
Etiology and Pathophysiology
Inflammation of the marginal gingiva. This can progress to deeper, destructive inflammation; if involving supporting bone, will be classified as periodontitis, not gingivitis (2)
- Usually noncontagious
- Inadequate plaque removal
- Blood dyscrasias (pregnancy)
- Medication induced (e.g., oral contraceptives, antiepileptics)
- Allergic reactions
- Nutritional deficiencies
- Vasoconstriction (nicotine, methamphetamine)
- Endocrine/hormonal variations
- Pregnancy, menses, menarche
- Chronic debilitating disease
- Vincent disease, necrotizing ulcerative gingivitis
- Synergistic infection with fusiform bacillus (Fusobacterium spp.) and spirochete (Borrelia vincentii)
- Pathology
- Acute or chronic inflammation
- Hyperemic capillaries
- Polymorphonuclear infiltration
- Papillary projections in subepithelial tissue
- Fibroblasts
Genetics
Possible genetic link (up to 30% of population); rare condition called hereditary gingival fibromatosis, where severe gingival hyperplasia covers teeth, associated with hirsutism
Risk Factors
- Poor dental hygiene/plaque formation
- Pregnancy
- Uncontrolled diabetes mellitus
- Malocclusion or dental crowding
- Smoking
- Mouth breathing
- Xerostomia
- Faulty dental restorations
- HIV-positive; AIDS
- Stress
- Hospitalization
- 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 teens and young adults
- Bronchial asthma and other respiratory diseases
- Rheumatoid arthritis
- Epilepsy
General Prevention
- Good oral hygiene
- Adults
- Regular twice-daily brushing with fluoride toothpaste
- May be increased benefit of using circular oscillating electric brush rather than regular brush or sonic/vibration, although evidence is inconclusive (2,3)
- Daily “high-quality” flossing (studies show that flossing only helps when it is done correctly) and interdental brushes (2,4)
- Chlorhexidine with oral hygiene better than other oral rinse agents (2,5)
- Use in acute phase (2).
- 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
- Adults
- Cleaning by a dentist or hygienist every 6 months or more frequently, as indicated (2)
- Mouth rinse with essential oils (menthol, thymol, eucalyptol; e.g., Listerine) combined with brushing (2)
- It had been thought that long-term use of alcohol-based mouth rinse may be associated with an increased risk of oral cancer. A recent systematic review found no evidence (2).
Commonly Associated Conditions
- Periodontitis
- Glossitis
- Pedunculated growths (pyogenic granulomata)
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