Gingivitis

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Basics

Description

Gingivitis is a reversible form of inflammation of the gingiva. It is a mild form of periodontal disease. Classification includes the following:

  • Plaque induced
  • Not plaque induced (bacterial, viral, or fungal; e.g., necrotizing ulcerative gingivitis, Vincent disease [“trench mouth”], denture related)
  • Modified by systemic factors (e.g., pregnancy, puberty, HIV, diabetes, smoking, leukemia)
  • Modified by medications (calcium channel blockers, antipsychotics, antiepileptics, antirejection medications, hormones)
  • Modified by malnutrition (vitamin deficiencies)
  • Acute or chronic
  • System(s) affected: gastrointestinal; ears, nose, throat; dental
  • Synonym(s): mild periodontal disease; gum disease

Geriatric Considerations
More frequent in this age group (due more to additive effects than to increased susceptibility)

Pediatric Considerations
Cases of plaque-induced gingivitis are common in children (most common form of pediatric periodontal disease) and usually require no specific interventions other than improved oral hygiene.

Pregnancy Considerations
  • Very common in pregnant women; hormonal effect
  • Self-limited

Epidemiology

  • Predominant age: children, teenagers, and young adults
  • Predominant sex: slightly more males than female
  • Prevalence ~50% of children
  • ~90% of adolescents and adult population
  • ~30–75% of pregnant women
  • 42% of adults in United States have periodontal diseases (1).

Etiology and Pathophysiology

Inflammation of the marginal gingiva. This can progress to deeper, destructive inflammation; if involving supporting bone, will be classified as periodontitis, not gingivitis (2)

  • Usually noncontagious
  • Inadequate plaque removal
  • Blood dyscrasias (pregnancy)
  • Medication induced (e.g., oral contraceptives, antiepileptics)
  • Allergic reactions
  • Nutritional deficiencies
  • Vasoconstriction (nicotine, methamphetamine)
  • Endocrine/hormonal variations
    • Pregnancy, menses, menarche
  • Chronic debilitating disease
  • Vincent disease, necrotizing ulcerative gingivitis
    • Synergistic infection with fusiform bacillus (Fusobacterium spp.) and spirochete (Borrelia vincentii)
  • Pathology
    • Acute or chronic inflammation
    • Hyperemic capillaries
    • Polymorphonuclear infiltration
    • Papillary projections in subepithelial tissue
    • Fibroblasts

Genetics
Possible genetic link (up to 30% of population); rare condition called hereditary gingival fibromatosis, where severe gingival hyperplasia covers teeth, associated with hirsutism

Risk Factors

  • Poor dental hygiene/plaque formation
  • Pregnancy
  • Uncontrolled diabetes mellitus
  • Malocclusion or dental crowding
  • Smoking
  • Mouth breathing
  • Xerostomia
  • Faulty dental restorations
  • HIV-positive; AIDS
  • Stress
  • Hospitalization
  • Vitamin C deficiency; coenzyme Q10 deficiency
  • Dental appliances (dentures, braces)
  • Eruption of primary or secondary teeth
  • Necrotizing ulcerative gingivitis
    • Stress
    • Lack of sleep
    • Malnutrition
    • Viral illness
    • Typically teens and young adults
  • Bronchial asthma and other respiratory diseases
  • Rheumatoid arthritis
  • Epilepsy

General Prevention

  • Good oral hygiene
    • Adults
      • Regular twice-daily brushing with fluoride toothpaste
      • May be increased benefit of using circular oscillating electric brush rather than regular brush or sonic/vibration, although evidence is inconclusive (2,3)
      • Daily “high-quality” flossing (studies show that flossing only helps when it is done correctly) and interdental brushes (2,4)
      • Chlorhexidine with oral hygiene better than other oral rinse agents (2,5)
        • Use in acute phase (2).
    • Pediatrics
      • Regular twice-daily brushing with fluoride toothpaste under parental supervision until full manual dexterity (~8 years of age)
      • Regular flossing if no spaces between teeth
  • Cleaning by a dentist or hygienist every 6 months or more frequently, as indicated (2)
  • Mouth rinse with essential oils (menthol, thymol, eucalyptol; e.g., Listerine) combined with brushing (2)
    • It had been thought that long-term use of alcohol-based mouth rinse may be associated with an increased risk of oral cancer. A recent systematic review found no evidence (2).

Commonly Associated Conditions

  • Periodontitis
  • Glossitis
  • Pedunculated growths (pyogenic granulomata)

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