Gum disease – Gingivitis

July 18, 2013 by Dr. Ng SN


Sequela of gum disease
Sequela of gum disease


Gingivitis is the inflammation of the gingiva due to bacterial infection that can occur at any age but most frequently arises during adolescence. It is a disease that requires the presence and maturation of bacterial plaque Gingivitis is diagnosed by bleeding and by changes in the colour, contour and consistency of the gingiva. Features include red swollen marginal gingiva; loss of stippling; red-purple, bulbous interdental papillae; and the increased fluid flow from the gingival crevice. Gingival bleeding and pain are induced by tooth-brushing and slight probing. Treatment of gingivitis consists of frequent and regular removal of plaque through dental scaling and root planing. If gingivitis is left untreated for a long period of time, it will lead periodontitis which will result in loosing teeth.

Other types of Gingivitis

i) Gingivitis caused by Mouth Breathing

Gingivitis caused by mouth breathing. Source: Color Atlas of Common Oral Disease
Gingivitis caused by mouth breathing. Source: Color Atlas of Common Oral Disease

Chronic mouth breathing is characterized by nasal obstruction, a high narrow palate vault, snoring, xerostomia, a sore throat upon wakening and a characteristic form of gingivitis. Soft tissue changes are limited to the anterior labia gingiva of the maxilla and sometimes , the mandible. These changes may be an incidental findings in conjunction with caries limited to the incisors. Early changes consist of diffuse redness of the labial, marginal and interdental gingiva. The interproximal papillae become red, bulbous and hemorrhagic. Progression results in inflammatory changes of the entire attached gingiva and bleeding upon probing. Improve oral hygiene reduces these signs but does not resolve the condition. Protective dressing placed on the affected gingiva promote healing. However, definitive treatment should address the reestablishment of a patent nasal airway.

ii) Acute Necrotizing Ulcerative Gingivitis (ANUG)

Gingivitis caused by mouth breathing. Source: Color Atlas of Common Oral Disease
Acute Necrotizing Ulcerative Gingivitis. Source: Color Atlas of Common Oral Disease

ANUG is atype of gingivitis that is linked to specific bactirial species and stress. The condition is also known as Vincent’s infection or “trench mouth”. This multifactorial disease has a bacterial population high in fusiform bacillae and spirochetes that are evident in smears viewed by dark-field microscopy. The condition is characterized by fever, lymphadenopathy, malaise, fiery red gingiva, extreame oral pain, hypersalivation and an unmistakable fetor oris. The interdental papillae are punched out, ulcerated and covered with a grayish pseudomembrane. The condition is common in persons between the age of 15 and 25 years, particularly students and military recruits enduring times of increased stress and reduced host resistance, and in HIV-infected patients. Treatment of ANUG requires irrigation, gentle debridement, antibiotics and stress reduction. Partial loss of interdental papillae can be expected despite normal healing.

iii) Actinomycotic Gingivitis

Gingivitis caused by mouth breathing. Source: Color Atlas of Common Oral Disease
Actinomycotic Gingivitis. Source: Color Atlas of Common Oral Disease

Actinomycotic gingivitis is a rare form of marginal gingivitis that presents with redness, intense burning pain and lack of response to normal therapeutic regimens. Biopsy of tissue revels the non-acid-fast, filamentous fungal organism. Gingivectomy or long-term antimicrobial therapy provides effective treatment.

iv) Hormonal Gingivitis

Pregnancy Gingivitis
Pregnancy Gingivitis. Source: Color Atlas of Common Oral Disease

It is a hyperplastic reaction to microbial plaque that generally affects women during puberty, pregnancy (more info on gingivitis during pregnancy) or menopause.  Elevation of estrogen or progesterone levels resulting from hormonal shifts and use of birth control pills have been implicated. These hormones enchance tissue vacularity, which permits an exaggerated inflammatory reaction to plaque. Hormonal gingivitis produces fiery red, swollen and tender marginal gingiva and compressible and swallon interdental papillae. Severity is related to microbial accumulation and poor hygiene. Hormonal gingivitis is usually transitory and responds to meticulous home care, oral prophylaxis and a decrease in hormone levels. Persistance results in fibrosis and pinker, firmer and lumpy tissues. Gingivectomy is needed to reduce fibrotic gingivae.

v) Diabetic Gingivitis

Diabetic Gingivitis. Source: Color Atlas of Common Oral Disease
Diabetic Gingivitis. Source: Color Atlas of Common Oral Disease

Diabetes mellitus is a common disease in Malaysia. This progressive metabolic disorder characterized by hyper glycemia, glucosuria, polyuria, polydipsia and pruritis. Poor control of blood glucose levels is related to lack of production or use of insulin. Complications of diabetes include many vascular-related problems, risk of infection, dry mouth, burning tongue sensation and persistant gingivitis In patient with uncontrolled diabetes, peculiar proliferations of exuberant tissue arise from the marginal and attached gingiva. The well-demarcated swellings are soft, red, irregular and haemorrhagic. The surface of the hyperplastic tissue is bulbous or papulonodular. Successful treatment requires meticulous home care and control of the blood glucose level with diet, hypoglycemic medications or insulin. (Read more: Gum Disease and diabetic)

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