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. 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.
As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary categories of gingival diseases, each with numerous subgroups:
- Dental plaque-induced gingival diseases.
- Gingivitis associated with plaque only/yes or no
- Gingival diseases modified by systemic factors
- Gingival diseases modified by medications
- Gingival diseases modified by malnutrition
- Non-plaque-induced gingival lesions
- Gingival diseases of specific bacterial origin
- Gingival diseases of viral origin
- Gingival diseases of fungal origin
- Gingival diseases of genetic origin
- Gingival manifestations of systemic conditions
- Traumatic lesions
- Foreign body reactions
- Not otherwise specified
Signs and symptoms
- 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.
- 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. 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.
It is recommended that a dental hygienist or dentist be seen after the signs of gingivitis appear. 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.
Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. 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. 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. 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.
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.
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.
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, 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.
- Tooth loss
- Recurrence of gingivitis
- Infection or abscess of the gingiva or the jaw bones
- Trench mouth (bacterial infection and ulceration of the gums)
- ^ The American Academy of Periodontology. Proceedings of the World Workshop in Clinical Periodontics. Chicago:The American Academy of Periodontology; 1989:I/23-I/24.
- ^ "Parameter on Plaque-Induced Gingivitis". Journal of Periodontology 71 (5 Suppl): 851–2. 2000. doi:10.1902/jop.2000.71.5-S.851. PMID 10875689.
- ^ Ammons, WF; Schectman, LR; Page, RC (1972). "Host tissue response in chronic periodontal disease. 1. The normal periodontium and clinical manifestations of dental and periodontal disease in the marmoset". Journal of periodontal research 7 (2): 131–43. PMID 4272039.
- ^ Page, RC; Schroeder, HE (1976). "Pathogenesis of inflammatory periodontal disease. A summary of current work". Laboratory investigation; a journal of technical methods and pathology 34 (3): 235–49. PMID 765622.
- ^ Armitage, Gary C. (1999). "Development of a Classification System for Periodontal Diseases and Conditions". Annals of Periodontology 4 (1): 1–6. doi:10.1902/annals.1922.214.171.124. PMID 10863370. http://perio.org/resources-products/classification.pdf.
- ^ Research, Science and Therapy Committee of the American Academy of Periodontology (2001). "Treatment of Plaque-Induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions". Journal of Periodontology 72 (12): 1790–1800. doi:10.1902/jop.2001.72.12.1790. PMID 11811516.
- ^ Hasturk, Hatice; Nunn, Martha; Warbington, Martha; Van Dyke, Thomas E. (2004). "Efficacy of a Fluoridated Hydrogen Peroxide-Based Mouthrinse for the Treatment of Gingivitis: A Randomized Clinical Trial". Journal of Periodontology 75 (1): 57–65. doi:10.1902/jop.2004.75.1.57. PMID 15025217.
- ^ American Dental Hygienists’ Association Position Paper on the Oral Prophylaxis, Approved by the ADHA Board of Trustees April 29, 1998
- ^ FDA Triclosan: What Consumers Should Know Accessed 2010-08-12
- ^ Calcium Reduces Risk for Gum Disease. Perio.org. Retrieved on 2011-04-30.
- ^ Good Oral Health Can Help Your Heart, Institute for Good Medicine at the Pennsylvania Medical Society, 2009.
- ^ Stoeken, Judith E.; Paraskevas, Spiros; Van Der Weijden, Godefridus A. (2007). "The Long-Term Effect of a Mouthrinse Containing Essential Oils on Dental Plaque and Gingivitis: A Systematic Review". Journal of Periodontology 78 (7): 1218–28. doi:10.1902/jop.2007.060269. PMID 17608576.
Periodontology Tissues of the periodontium
and their physiologic entities
Diagnoses Pathogenesis Pathologic entitiesCalculus · Clinical attachment loss · Edentulism · Fremitus · Furcation defect · Gingival enlargement · Gingival pocket · Gingivitis · Horizontal bony defect · Linear gingival erythema · Occlusal trauma · Periodontal pocket · Periodontal disease · Periodontitis · Plaque · Recession · Vertical bony defect Diagnosis, treatment planning,
Periodontal armamentarium Conventional therapy Surgical therapy and
periodontal surgeryApically positioned flap · Bone graft · Coronally positioned flap · Crown lengthening · Open flap debridement · Free gingival graft · Gingivectomy · Guided bone regeneration · Guided tissue regeneration · Implant Placement · Lateral pedicle graft · Pocket reduction surgery · Sinus lift · Subepithelial connective tissue graft
Important personalities Other specialtiesEndodontology · Orthodontology · Prosthodontology Oral pathology: Stomatognathic disease (K06, K11–K14, 523, 527–529) Vestibule of mouth Oral cavity properHard, soft,
and periapical tissues
Salivary glands Tongue General To be grouped
from dermAcquired dyskeratotic leukoplakia · Angina bullosa haemorrhagica · Behçet syndrome · Cutaneous sinus of dental origin · Cyclic neutropenia · Epulis fissuratum · Eruptive lingual papillitis · Melanocytic oral lesion · Melkersson–Rosenthal syndrome · Mucosal lichen planus · Oral Crohn's disease · Oral florid papillomatosis · Oral melanosis · Plasmoacanthoma · Proliferative verrucous leukoplakia · Pyogenic granuloma · Pyostomatitis vegetans · Recurrent intraoral herpes simplex infection · Stomatitis nicotina · Trumpeter's wart · Vestibular papillomatosis
Inflammation Acute Chronic Processes Specific locationsCardiovascularDigestivemouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis
- Dental plaque-induced gingival diseases.
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