Gingivitis
Encyclopedia
Gingivitis 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.
While in some sites or individuals, gingivitis never progresses to periodontitis, data indicate that periodontitis is always preceded by gingivitis.
s of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation:
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.
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.
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-ray
s 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.
that includes daily brushing
and flossing. Interdental brush
es 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.
, 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.
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
. The most common form of gingivitis is in response to bacterial biofilms (also called plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
) adherent to tooth surfaces, termed plaque-induced gingivitis, and is the most common form of periodontal disease
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
. In the absence of treatment, gingivitis may progress to periodontitis, which is a destructive form of periodontal disease.
While in some sites or individuals, gingivitis never progresses to periodontitis, data indicate that periodontitis is always preceded by gingivitis.
Classification
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
The symptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s 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
Stippling (dentistry)
The gingiva often possess a textured surface that is referred to as being stippled . Stippling only presents on the attached gingiva bound to underlying alveolar bone, not the freely moveable alveolar mucosa...
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
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
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. The plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...
accumulates in the small gaps between teeth, in the gingival grooves
Gingival sulcus
The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival...
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
Calculus (dental)
In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...
(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
Lipopolysaccharide
Lipopolysaccharides , also known as lipoglycans, are large molecules consisting of a lipid and a polysaccharide joined by a covalent bond; they are found in the outer membrane of Gram-negative bacteria, act as endotoxins and elicit strong immune responses in animals.-Functions:LPS is the major...
(LPS, otherwise known as endotoxin
Endotoxin
Endotoxins are toxins associated with some Gram-negative bacteria. An "endotoxin" is a toxin that is a structural molecule of the bacteria that is recognized by the immune system.-Gram negative:...
) or lipoteichoic acid
Lipoteichoic acid
Lipoteichoic acid is a major constituent of the cell wall of Gram-positive bacteria. These organisms have an inner membrane and, external to it, a thick peptidoglycan layer. It consists of teichoic acids, long chains of ribitol phosphate and is anchored to the lipid bilayer via a glyceride...
(LTA), that promote an inflammatory response in the gum tissue. This inflammation can cause an enlargement of the gingiva and subsequent formation.
Diagnosis
It is recommended that a dental hygienistDental hygienist
thumb|right|300px|Dental hygienist holding a scalerA dental hygienist is a licensed dental professional who specializes in preventive oral health, typically focusing on techniques in oral hygiene. Local dental regulations determine the scope of practice of dental hygienists...
or dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
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-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s 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 hygieneOral hygiene
Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...
that includes daily brushing
Tooth brushing
Tooth brushing is the act of cleaning teeth with a toothbrush.Modern medical research has shown that brushing teeth properly can prevent cavities, and periodontal, or gum disease, which causes at least one-third of adult tooth loss. If teeth are not brushed correctly and frequently, it could lead...
and flossing. Interdental brush
Interdental brush
An interdental brush, also called an interproximal brush or a proxy brush, is a small brush, typically disposable and supplied with a reusable angled plastic handle, used for cleaning between teeth and between the wire of dental braces and the teeth. Brushes are available in a range of...
es are also useful in cleaning the teeth from plaque. Hydrogen peroxide
Hydrogen peroxide
Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...
, saline
Saline
Saline may refer to:* Salinity, the salt content of a solution** Saline water, water containing significant concentration of salts* Soil salinity, salt content of soil* Saline , a liquid with salt content to match the human body...
, alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...
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
American Dental Association
The American Dental Association is an American professional association established in 1859 which has more than 155,000 members. Based in Chicago, the ADA is the world's largest and oldest national dental association and promotes good oral health to the public while representing the dental...
, periodontal scaling
Scaling and root planing
The objective of scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is to remove or eliminate the etiologic agents which cause inflammation: dental plaque, its products and calculus, thus helping to establish a...
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
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) found clear evidence which showed that toothpaste containing triclosan
Triclosan
Triclosan is an antibacterial and antifungal agent. It is a polychloro phenoxy phenol. Despite being used in many consumer products, beyond its use in toothpaste to prevent gingivitis, there is no evidence according to the American Food and Drug Administration that triclosan provides an extra...
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
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
consumption and periodontal disease
Periodontal disease
Periodontitis is a set of inflammatory diseases affecting the periodontium, i.e., the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth...
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
Pennsylvania Medical Society
The Pennsylvania Medical Society is the professional association for the state’s physicians and physicians in training.Headquartered in Harrisburg, Pa., the non-profit organization represents about 20,000 physicians, residents, fellows, medical students, and practice administrators.The Pennsylvania...
, good oral health can reduce risk of cardiac events. Poor oral health can lead to infections that can travel within the bloodstream.
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, curettageCurettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....
, 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.
Complications
- Tooth loss
- Recurrence of gingivitis
- Periodontitis
- Infection or abscessAbscessAn abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
of the gingiva or the jaw bones - Trench mouthTrench mouthAcute necrotizing ulcerative gingivitis or necrotizing ulcerative gingivitis is a sub-classification of necrotizing periodontal disease, an infection of the gum tissue. This presents as an acute infection of the gingiva without involvement of the other tissues of the periodontium...
(bacterial infection and ulceration of the gums)
External links
- Gum disease treatment Information on Gum disease treatment
- Gingivitis – Medline plus