GINGIVITIS

Definition:
 Inflammation of the gingiva characterized by swelling, redness, change of normal contours,
exudates, and bleeding
 Gingivitis is an acute or chronic inflammation of the gingivae and occurs as the result of
the action of bacteria that accumulate on the teeth and gingivae, and form plaque

Classification of gingivitis:
i. Acute gingivitis
 Acute ulcerative gingivitis
 Acute non-specific gingivitis
ii. Chronic gingivitis

Causes:
 Poor oral hygiene, which allows plaque  Vincent's - fusiform bacillus or
to accumulate or inadequate plaque spirochete infection
removal  Allergic reactions
 Malocclusion,  Endocrine disturbances, i.e. pregnancy,
 Dental calculus, menses
 Food impaction,  Chronic debilitating disease
 Faulty dental restorations,  Gingivitis may be an early sign of a
 Xerostomia (A dryness of the mouth) systemic disorder, such as 1O HSV,
 Blood dyscrasias hypovitaminosis, a leukopenic
 Reaction to oral contraceptives (may disorder, DM, or AIDS.
exacerbate inflammation)  Exposure to heavy metals (e.g. lead,
bismuth).

Pathogenesis
 Bacteria-predominantly anaerobic filamentous rods, spirochetes, & gram-negatives-are
commonly present.

Signs and symptoms:

 Halitosis  subgingival plaque/calculus is present
 Gum swelling (painless)  Edema of interdental papillae
 Gum redness  Narrow band of bright red inflamed gum
 Change of normal gum contours surrounding neck of tooth
 Gum bleeding on flossing, brushing or  Vincent's angina - ulcers, fever,
dental probing malaise, regional lymphadenopathy, pain

Treatment
 Prevents progression to the more severe periodontitis.
General measures:
 Remove irritating factors (plaque,  No smoking
calculus, faulty dentures)  Prophylactic antibiotics
 Oral hygiene & Warm saline rinses twice  If these are ineffective, use a topical anti-
daily infective mouthwash (e.g. chlorhexidine
 Regular dental check-ups gluconate solution)

Medications
 Antibiotics indicated only for acute necrotizing ulcerative gingivitis (Vincent's angina)
 Antibiotics, e.g., penicillin V, pediatric dose 25-50 mg/kg/day divided q6h; adult dose 250-
500 mg q6h, or
 Erythromycin - pediatric dose 30-40 mg/kg/day divided q6h; adult dose 250 mg q6h
 Topical corticosteroids e.g., triamcinolone in Orabase)

1. ACUTE GINGIVITIS
a) Acute ulcerative gingivitis / Vincent’s gingivitis
Definition: (Acute necrotizing ulcerative gingivitis.)
 Acute ulcerative gingivitis is a distinct and specific disease characterised by rapidly
progressive ulceration typically starting at the tips of the interdental papillae, spreading
along the gingival margins and going on to acute destruction of the periodontal tissues.

Aetiology
 The bacteria responsible are spirochaetes & fusiforms termed Borrelia vincentii and
Fusobacterium nucleatum.
 Like other anaerobic infections, ulcerative gingivitis is a mixed infection with the main
pathogens dependent on other bacteria.
 Ulcerative gingivitis is a disease of otherwise healthy young adults usually with dirty
neglected mouths
 Ulcerative gingivitis may develop in children having immunosuppressive treatment and in
patients with HIV infection.

Predisposing factors
 Malnutrition  Smoking
 Stress  Upper respiratory infections
 Chronic anxiety  Peripheral vasoconstritor action of
nicotine

Clinical features
 Soreness & gingival bleeding (after minimal trauma, much more than in chronic gingivitis)
are the main complaints.
 Excessive salivation
 The breath is unpleasant as might be expected of an anaerobic infection causing tissue
necrosis.
 Most patients have neglected mouths with accumulations of plaque and calculus.
 The accumulation of plaque may partly be due to the pain preventing effective tooth-
brushing after onset of infection.

The local lesion

 Crater-shaped or punched-out ulcers form primarily at the tips of the interdental papillae.
 The edges are sharply defined by erythema and oedema of the margins, while the surface of
the ulcer is covered by a greyish or yellowish tenacious slough. Removal of the slough
causes free bleeding.

Investigation
 A swab taken from the deep aspect of the slough shows a heavy predominance of
spirochaetes and fusiform bacilli.

Differential diagnosis
1. Primary herpetic 2. Acute leukemia
stomatitis 3. Agranulocytosis

Treatment
1. Physical (oral hygiene) measures
 Plaque and Calculus must be removed by careful and thorough scaling and irrigation.
 Toothbrushing and frequent use of mouthwashes of a hot dilute antiseptic
2. Metronidazole
 The usual dose is 250 mg P.O TID for 3 days. The tablets should be taken after food.
3. Oxidising antiseptics.
 The most commonly used was hydrogen peroxide applied directly to the gingiva with
general cleaning up the mouth.

b) Acute non-specific gingivitis

 This is commonly associated with herpetic stomatitis or acute streptococcal sore throat or
other febrile infections.
 Gingivitis here doesn’t seem to be a specific infection & is probably an exacerbation of pre-
existing chronic gingivitis.
 The gingivae tend to be bright red and oedematous.
 The swelling causes the surface to lose its stippling and to appear glossy.
 There may be slight soreness of the gingivae, or symptoms may be absent.
The treatment is that of the underlying infection and measures to improve oral hygiene.

2. CHRONIC GINGIVITIS
 Chronic gingivitis, an almost universal disease, is a persistent low grade infection resulting
from accumulation of bacterial plaque—round the necks of the teeth.
 Adequate toothbrushing will remove the deposits from the teeth and eliminate chronic
gingivitis. Failure to prevent the accumulation these deposits is usually followed by spread
 of infection and inflammation, together with increasing damage to the periodontal
membrane and alveolar bone.
 The condition of chronic periodontitis with progressive destruction of supporting tissues
thus becomes established.

3. OTHER FORMS:
Pregnancy gingivitis
 Augmented cutaneous blood flow in pregnancy is associated with marked decreases in
peripheral vascular resistance
 This is thought to serve to dissipate excess heat generated by increased metabolism.
 There are a number of presumably estrogen-induced changes in the small vessels that are
encountered frequently.
 Pregnancy gingivitis is caused by growth of the gum capillaries-epulis of pregnancy which
becomes worse as gestation progresses, but it may be controlled by proper dental hygiene &
avoidance of trauma.
 During pregnancy, the gingiva may become mildly inflamed; hyperplasia, especially of the
interdental papillae, is likely.
 Pedunculated gingival growths (pregnancy tumors) often arise in the interdental papillae
during the first trimester, may persist throughout pregnancy, and may or may not subside
after delivery.
 Pregnancy tumors are soft reddish masses that develop rapidly and then remain static. There
is often an underlying irritant, such as calculus or a rough margin of a restoration.