Perio Other – Gingivitis

Gingivitis is a non-destructive disease which causes gum inflammation. The most common form of gingivitis occurs in response to plaque which is attached to surface of the teeth. Most forms of gingivitis are caused by plaque.

Not every case of gingivitis progresses into periodontitis, however, gingivitis always occurs before periodontitis.

Gingivitis can be reversed through improved oral hygiene. When it is left untreated, however, gingivitis can progress into periodontitis. With periodontitis, the chronic inflammation of the gums causes destruction of tissue and the bone which surrounds the teeth resorbs. In the most severe cases, periodontitis can cause tooth loss.

Signs and Symptoms

Below are common signs and symptoms of gingivitis:

  • Bad breath or halitosis
  • Bleeding gums, common after brushing and/or flossing
  • Bright red or purple gums
  • Swollen and inflamed gums
  • Tender gums that are painful to the touch

In addition, it is common for the stippling, which is normally present in healthy gum tissue, often disappears when gingivitis is present. The gums may appear to be shiny because the gum tissue is swollen and stretched over the inflamed connective tissue. The accumulation of plaque may also cause an unpleasant odor in the mouth. When the gums are swollen, the epithelial lining of the gingival crevice becomes ulcerated and the gums often bleed more easily. Even the gentlest brushing and flossing can cause bleeding.

Complications of gingivitis:

  • Associated with premature birth and a low birth weight
  • Future cases of gingivitis
  • Infections or abscess of the gingiva and jaw bones
  • Periodontitis
  • Swollen lymph nodes
  • Trench mouth

Alzheimer's and Dementia

In 2018, a study found evidence which suggested that gingivitis bacteria may be linked to Alzheimer's disease. Scientists are in agreement that additional research is needed before they can make a connection. Studies found in mice that 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. Once the bacteria is in the brain, it was able reproduce features similar to Alzheimer’s disease.

Cause

Gingivitis is caused by bacterial plaque, which acts to initiate the body's host response. This can result in the destruction of gingival tissues which may progress to the destruction of the periodontal attachment apparatus. The plaque accumulates in the small gaps between teeth, in gingival grooves and in other areas which are called plaque traps. Plaque traps can include bulky and overhanging restorative margins, clasps of removable partial dentures and tartar which forms on the teeth over time. While these accumulations may be small, the bacteria produces chemicals triggering an inflammatory response in the gums.

Risk factors

The following are risk factors associated with gingivitis:

  • Age
  • Aggressive oral hygiene; brushing with stiff bristles
  • Genetic factors
  • Inadequate dental care
  • Medications and conditions that cause the mouth to be dry
  • Mental health issues such as depression
  • Mouth-breathing during sleep
  • Osteoporosis
  • Pre-existing conditions such as diabetes
  • Poor oral hygiene or neglect
  • Smoking
  • Stress

Diagnosis

Gingivitis is a type of periodontal disease which often includes inflammation and bleeding. Each tooth is separated into four gingival units which includes mesial, distal, buccal and lingual. The teeth are then assigned a score ranging 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 gingivitis based on their clinical assessment and data obtained during a thorough periodontal exam.