gingivitis

Gingivitis
Classification and external resources
Severe gingivitis before (top) and after (bottom) a thorough mechanical debridement of the teeth and adjacent gum tissues
ICD-10	K05.0-K05.1
ICD-9	523.0-523.1
DiseasesDB	34517
MedlinePlus	001056
MeSH	D005891

Gingivitis ("inflammation of the gum tissue") is a term used to describe non-destructive periodontal disease.^[1] The most common form of gingivitis is in response to bacterial biofilms (also called plaque) adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease. In the absence of treatment, gingivitis may progress to periodontitis, which is a destructive form of periodontal disease.^[2]

While in some sites or individuals, gingivitis never progresses to periodontitis,^[3] data indicate that periodontitis is always preceded by gingivitis.^[4]

Classification

As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary categories of gingival diseases, each with numerous subgroups:^[5]

1. Dental plaque-induced gingival diseases.
   1. Gingivitis associated with plaque only
   2. Gingival diseases modified by systemic factors
   3. Gingival diseases modified by medications
   4. Gingival diseases modified by malnutrition
2. Non-plaque-induced gingival lesions
   1. Gingival diseases of specific bacterial origin
   2. Gingival diseases of viral origin
   3. Gingival diseases of fungal origin
   4. Gingival diseases of genetic origin
   5. Gingival manifestations of systemic conditions
   6. Traumatic lesions
   7. Foreign body reactions
   8. Not otherwise specified

Signs and symptoms

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

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.

Cause

Because 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.^[6] 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.

Diagnosis

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.

Prevention

Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing.^[7] Interdental brushes are also useful in cleaning the teeth from plaque. Hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes may also be employed. In a recent clinical study, the beneficial effect of hydrogen peroxide on gingivitis has been highlighted.^[8] 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 to periodontal disease, not as a preventive treatment for periodontal disease.^[9] In a 1997 review of effectiveness data the U.S. Food and Drug Administration (FDA) found clear evidence which showed that toothpaste containing triclosan was effective in preventing gingivitis.^[10]

In many countries, such as the United States, mouthwashes containing chlorhexidine are available only by prescription.

Researchers analyzed government data on calcium consumption and periodontal disease indicators in nearly 13,000 U.S. adults. They found that men and women who had calcium intakes of fewer than 500 milligrams, or about half the recommended dietary allowance, were almost twice as likely to have gum disease, as measured by the loss of attachment of the gums from the teeth. The association was particularly evident for people in their 20s and 30s.^[11]

Preventing gum disease may also benefit a healthy heart. According to physicians with The Institute for Good Medicine at the Pennsylvania Medical Society, good oral health can reduce risk of cardiac events. Poor oral health can lead to infections that can travel within the bloodstream.^[12]

Treatment

The focus of treatment for gingivitis is removal of the etiologic (causative) agent, 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,^{[contradictory]} mouth washes containing chlorhexidine or hydrogen peroxide, and flossing. Interdental brushes also help remove any causative agents.

Recent scientific studies have also shown the beneficial effects of mouthwashes with essential oils.^[13]

Furthermore, oral Non-Steroidal Anti-Inflammatory Drug (NSAID) rinses are a relatively new treatment modality for treating inflammation in the oral cavity. NSAIDs such as ibuprofen or diclofenac, are a mainstay of analgesic and anti-inflammatory treatment in dentistry. However, the systemic use of NSAID's are associated with several side-effects, namely cardiovascular thrombotic events, such as myocardial infarction and stroke, gastric irritability or ulcerogenic effects, blood dyscrasias, and nephrotoxicity; among these gastric irritability is most common. Therefore, it is preferable to use local formulations such as a mouthwash to treat oral inflammatory conditions e.g. gingivitis. A randomized, investigator-blind, clinical study published in September, 2011 , showed the new Diclofenac Epolamine (diclofenac N-(2-hydroxyethyl) Pyrrolidine; DHEP), a diclofenac salt with greater water solubility, as an effective and tolerable medicinal product for symptomatic and post-surgical relief of inflammation of the oral cavity.^[14] Volunteers with inflammatory conditions, of which gingivitis was most prevalent, treated with DHEP, experienced a significantly greater reduction in pain and inflammation and were also free of pain and inflammatory symptoms as soon as Day 3 of the study compared to those treated with merely 0.0075% diclofenac mouthwash.^[15] There was an even greater reduction relative to the placebo group.^[16]

Moreover, studies published in the Journal of Periodontology comparing the NSAID’s, Celcoxib or Etorcoxib and the corticosteroid, dexamethasone also showed the power and efficacy of using proper NSAID therapy to combat oral inflammation.^[17] The results of these studies showed the use of celecoxib or dexamethasone as effective for the prevention and preemptive control of postoperative pain after periodontal surgery.^[18]

Complications

• Tooth loss, or decay
• Recurrence of gingivitis
• Periodontitis
• Infection or abscess of the gingiva or the jaw bones
• Trench mouth (bacterial infection and ulceration of the gums)
• swollen glands

See also

Dentistry portal

• Periodontist
• Periodontitis

References

External links

• Gum disease treatment Information on Gum disease treatment
• Gingivitis – Medline plus