Gingivitis, also known as ulitis, is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease, is in response to bacterial biofilms (also called plaque) that are attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced. Although gingivitis does not always progress to periodontitis, periodontitis is always preceded by gingivitis. Gingivitis is reversible with good oral hygiene; however, without treatment, gingivitis can progress to periodontitis, in which the inflammation of the gums results in tissue destruction and bone resorption around the teeth. Periodontitis can ultimately lead to tooth loss.
Signs and symptoms
The signs and symptoms of gingivitis include:
Swollen gums Bright red gums Gums that are tender or painful to the touch Bleeding gums or bleeding after brushing and/or flossing Bad breath (halitosis) Additionally, the stippling that normally exists in the gum tissue will often disappear, and the gums may appear shiny as the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. The gingiva may become ulcerated and the gums may bleed with even gentle probing or brushing, and especially when flossing.
Complications Gingival recession Chronic periodontitis Aggressive periodontitis Necrotizing gingivitis and other necrotizing periodontal diseases In addition to the above, there is limited data to suggest an association between gingivitis and premature birth, low birth weight, and Alzheimer's disease.
Cause
The cause of plaque-induced gingivitis is bacterial plaque, which acts to initiate the body's host response. This, in turn, can lead to destruction of the gingival tissues, which may progress to destruction of the periodontal attachment apparatus. The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that accumulate and maintain plaque. Examples of plaque traps include bulky and overhanging restorative margins, clasps of removable partial dentures, and calculus (tartar) that forms on teeth. Although these accumulations may be tiny, the bacteria in them produce chemicals, such as degradative enzymes, and toxins, such as lipopolysaccharide (LPS, otherwise known as endotoxin) or lipoteichoic acid (LTA), that promote an inflammatory response in the gum tissue. This inflammation can cause an enlargement of the gingiva and subsequent formation. Early plaque in health consists of a relatively simple bacterial community dominated by Gram-positive cocci and rods. As plaque matures and gingivitis develops, the communities become increasingly complex with higher proportions of Gram-negative rods, fusiforms, filaments, spirilla and spirochetes. Later experimental gingivitis studies, using culture, provided more information regarding the specific bacterial species present in plaque. Taxa associated with gingivitis included Fusobacterium nucleatum subspecies polymorphum, Lachnospiraceae [G-2] species HOT100, Lautropia species HOTA94, and Prevotella oulorum (a species of Prevotella bacterium), whilst Rothia dentocariosa was associated with periodontal health. Further study of these taxa is warranted and may lead to new therapeutic approaches to prevent periodontal disease, including systemic health.
Risk factors Risk factors associated with gingivitis include the following:
poor oral hygiene overly aggressive oral hygiene, such as brushing with stiff bristles orthodontic braces medications and conditions that dry the mouth cigarette smoking pre-existing conditions such as diabetes drinking obesity.
Diagnosis Gingivitis is a category of periodontal disease in which there is no loss of bone, but inflammation and bleeding are present. Each tooth is divided into four gingival units (mesial, distal, buccal, and lingual) and given a score from 0–3 based on the gingival index. The four scores are then averaged to give each tooth a single score. The diagnosis of the periodontal disease, gingivitis, is made by a dentist. The diagnosis is based on clinical assessment data acquired during a comprehensive periodontal examination. Either a registered dental hygienist or a dentist may perform the comprehensive periodontal examination, but the data interpretation and diagnosis are done by the dentist. The comprehensive periodontal examination consists of a visual examination, a series of radiographs, probing of the gingiva, determining the extent of current or past damage to the periodontium, and a comprehensive review of the medical and dental histories. Current research shows that activity levels of the following enzymes in saliva samples are associated with periodontal destruction: aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and acid phosphatase (ACP). Therefore, these enzyme biomarkers may be used to aid in the diagnosis and treatment of gingivitis and periodontitis. A dental hygienist or dentist will check for the symptoms of gingivitis and may also examine the amount of plaque in the oral cavity. A dental hygienist or dentist will also look for signs of periodontitis using X-rays or periodontal probing as well as other methods. If gingivitis is not responsive to treatment, referral to a periodontist (a specialist in diseases of the gingiva and bone around teeth and dental implants) for further treatment may be necessary.
Classification As defined by the 2017 World Workshop, periodontal health, gingival diseases/ conditions have been categorised into the following:
Periodontal health and gingival health Clinical gingival health on an intact periodontium Clinical gingival health on a reduced periodontium Stable periodontitis patient Non-periodontitis patient Gingivitis – dental biofilm-induced Associated with dental biofilm alone Mediated by systemic or local risk factors Drug-influenced gingival enlargement Gingival diseases – non-dental biofilm induced Genetic/ developmental disorders Specific infections Inflammatory and immune conditions Reactive processes Neoplasms Endocrine, nutritional & metabolic diseases Traumatic lesions Gingival pigmentation
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