General Dentistry Concepts: Gingivitis
Gingivitis is a non-destructive disease which results in inflammation of the gums. The most common form of gingivitis is in response to bacterial biofilms or plaque that is attached to tooth surfaces. Most forms of gingivitis are caused by plaque.
Not all cases of gingivitis progress to periodontitis, however, gingivitis always occurs before periodontitis.
Gingivitis can be reversed with improved oral hygiene. If untreated, however, gingivitis can lead to periodontitis. With periodontitis the chronic inflammation of the gums results in tissue destruction and bone resorption around the teeth. Periodontitis in severe cases can ultimately lead to tooth loss.
Signs and symptoms
The following are symptoms of gingivitis which manifest in the gum tissue as inflammation:
- Swollen gums
- Bright red or purple gums
- Tender gums that are painful to the touch
- Bleeding gums or bleeding after brushing and/or flossing
- Bad breath or halitosis
Additionally, the stippling that normally exists in the gum tissue of some individuals will often disappear. The gums may appear to be shiny when the gum tissue is swollen and stretched over the inflamed underlying connective tissue. The accumulation may also cause an unpleasant odor. When the gingiva are swollen, the epithelial lining of the gingival crevice becomes ulcerated and as a result, the gums can bleed more easily. Even gentle brushing and flossing can result in bleeding.
- Future cases of gingivitis
- Infection or abscess of the gingiva or the jaw bones
- Trench mouth
- Swollen lymph nodes
- Associated with premature birth and low birth weight
Alzheimer's and Dementia
In 2018, a new study found compelling evidence that gingivitis bacteria could be linked to Alzheimer's disease. Scientists agree that additional research is required before proving a cause and effect link. Studies found the bacteria, P. gingivalis, which is responsible for many forms of gum disease, can migrate from where it initiated in the mouth to the brain in mice. Once it is in the brain, P. gingivalis is able reproduce the characteristic features of Alzheimer’s disease.
Bacterial plaque is the cause of gingivitis, which acts to initiate the body's host response. This can result in the destruction of the gingival tissues which may progress to the destruction of the periodontal attachment apparatus. The plaque accumulates within the small gaps located between teeth, in the gingival grooves and in other areas known as plaque traps. Plaque traps can include bulky and overhanging restorative margins, clasps of removable partial dentures and tartar that forms on the teeth over time. Although these accumulations may be small, the bacteria in them produce chemicals that trigger an inflammatory response in the gum tissue. This inflammation can result in an enlargement of the gingiva and subsequent formation.
The following risk factors are associated with gingivitis:
- Low or infrequent dental care
- Poor oral hygiene and neglect
- Aggressive oral hygiene; brushing with stiff bristles
- Mouth-breathing during sleep
- Medications and conditions that cause the mouth to be dry
- Genetic factors
- Mental health issues such as depression
- Pre-existing conditions such as diabetes
Gingivitis is a type of periodontal disease where there is no bone loss, but inflammation and bleeding can occur. Each tooth is divided into four gingival units which include mesial, distal, buccal and lingual. The teeth are then given a score which ranges from 0-3 based on the gingival index. The four scores are then averaged to give each tooth a single score. A dentist will diagnosis periodontal disease gingivitis. The diagnosis is based on clinical assessment data which is obtained during a comprehensive periodontal exam.