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Gingivitis

Introduction

Gingivitis is the medical term for inflammation of the gingiva or gums, the soft tissue surrounding your tooth structure. It is the most prevalent gingival disease. Unlike periodontitis which is inflammation of the supporting tissues surrounding the tooth, gingivitis is reversible in most cases and can be treated with proper maintenance of oral hygiene.

Causes

The primary cause of gingivitis is the sticky layer formed on your tooth structure known as plaque. Plaque is a biofilm that deposits on our teeth regularly. It contains several different types of bacteria, salivary proteins, food debris, and other substances that stick to the outer layer of teeth. If not cleaned regularly, the bacteria within plaque trigger our immune system, leading to an inflammatory response. This causes swelling of gums, redness, and bleeding, which might be spontaneous or occur after brushing your teeth. Diabetes, hormonal changes, less salivary flow rate, and nutritional deficiency might also contribute to gingivitis.

Types

Based on the onset duration, gingivitis is generally divided into acute gingivitis and chronic gingivitis.

Acute gingivitis or Acute Necrotizing Ulcerative Gingivitis (ANUG) is a severe form of gingivitis that occurs mainly in patients with a compromised immune system. It is a painful condition characterized by crater-like lesions of the gums, bleeding, and foul breath.

Chronic gingivitis is the most prevalent form of gingivitis, resulting from bacterial plaque accumulation. It is usually painless and reverted with good teeth and surrounding gums.

Risk Factors and Epidemiology

There are several risk factors for gingivitis. The most common risk factor is the ill maintenance of oral hygiene. If plaque accumulation is not brushed off within 48 hours, it triggers your immune system and causes inflammation. On the other hand, overzealous brushing might also irritate your gums. Gingivitis also has a risk of occurring more frequently with growing age. Another risk factor is hormonal fluctuations due to stress, anxiety, menstruation, and pregnancy. Patients with diabetes, immune-compromised diseases, genetic disorders, and stress disorders are also susceptible. Smoking is a major external factor that contributes to gingivitis. It should also be noticed that if you have braces or any other orthodontic appliance, the risk of developing gingivitis is higher since there is a greater chance of plaque accumulation on artificial materials.

Chronic gingivitis occurs in almost every 3 out of 5 individuals. It’s the most commonly occurring gingival disease across the world. The prevalence of gingivitis is more among the adult population, especially in elders above 50, compared to children.

Signs and Symptoms

The most common symptoms of gingivitis include redness, swelling of gums, and frequent bleeding from gingival tissues. Some patients might experience bad breath as well. In most cases, it is painless, but the occurrence of pain depends on the severity of the disease.

A periodontal probe may initiate bleeding during a regular dental checkup, a meaningful clinical sign of gingivitis. It can be treated with ease at an early stage.

Diagnosis

A dentist makes the diagnosis of gingivitis after a thorough clinical examination. If redness and swelling are visible upon clinical examination, that is taken as an early sign of gingivitis. Your dentist might employ a periodontal probe to gauge the depth of gingival pockets and exclude the possibility of periodontitis. If your gum bleeds when they are probed, that is also a meaningful diagnostic sign of gingivitis. In some cases, panoramic radiographs might be necessary to visualize the depth of gingival pockets and any bone loss.

Differential Diagnosis

Other diseases in which the patient might experience the signs and symptoms of gingivitis include lichenoid reactions, pemphigus Vulgaris, systemic lupus erythematosus, aphthous ulcers, Crohn’s disease, dental abscess, and scurvy. The dentist has to diagnose gingivitis based on medical history and clinical examination.

Treatment

In cases of early-stage gingivitis, plaque removal by mechanical means is the most suggested treatment option. Brushing twice a day, flossing, and using chlorhexidine or hydrogen peroxide-containing mouthwashes is beneficial for removing plaque. If plaque has mineralized to form a rigid structure called calculus, it is much harder to remove with regular brushing. In that case, your dentist will suggest scaling and root planning to remove plaque and calculus. This treatment, followed by well-maintained oral hygiene, restores gums to normal.

In patients with underlying diseases that lead to gingivitis, it is necessary to treat the primary cause first to have a satisfactory treatment. Diabetic patients require maintenance of their sugar levels to reduce the recurrence of gingivitis.

Medications

Generally, gingivitis's most preferred treatment method is mechanical debridement of plaque—which involves at-home care and treatment at a dental clinic. In a few cases, oral antibiotics such as metronidazole are prescribed to reduce the number of oral bacteria causing inflammation of the gums.

Prognosis

In most cases, gingivitis is reversible, and with proper cleaning and maintenance, the overall prognosis of this disease is good. If a person has been presenting the symptoms of Acute Necrotizing Ulcerative Gingivitis (ANUG), the forecast, in that case, depends upon early diagnosis and treatment. Regular visits to your dentist and following dental guidelines can improve the prognosis of this disease.

Prevention

As mentioned earlier, the primary way to prevent gingivitis is to maintain oral hygiene. The use of toothpaste with antiseptic agents can be beneficial. If you have persisting gaps between your teeth, it is necessary to keep them clean by using an interdental brush. Antiseptic mouthwashes are also helpful since they can reach deep inner pockets that regular brushing cannot clean. However, it is essential to remember that brushing should not be done with too much force since it can damage the gums. Dentists usually recommend a toothbrush with soft bristles for regular cleaning of teeth. Smokers should endeavor to limit or quit smoking to avoid the risk of gingivitis. Patients with other risk factors should have regular dental checkups at least twice a year to prevent the development of this disease.