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.

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
• 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)