Inflamed soft tissues around teeth due to lack of proper oral hygiene.

Leads to accumulation of plaque and calculus.

Chronic changes are characterized by gingival redness, swelling, bleeding, shape changes and loss of soft tissue adaptation to teeth.

Most prevalent and severe in adolescence, but can occur at any age.

A reversible process, by controlling accumulation of plaque and calculus by good dental hygiene with brushing and flossing.

Refers to inflammation of the gum tissue.

It is a non-destructive disease that occurs around the teeth.

The most common form of gingivitis, and the most common form of periodontal disease, occurs in response to bacterial biofilms.

Bacterial biofilms, plaque, is attached to tooth surfaces, and causes plaque-induced gingivitis.

Some cases of gingivitis do not progress to periodontitis.

Periodontitis is always preceded by gingivitis.

Gingivitis is reversible with good oral hygiene.

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.

The symptoms and signs of gingivitis:

Swollen gums

Bright red or purple gums

Gums that are tender or painful to the touch

Bleeding gums or bleeding after brushing and/or flossing

Bad breath

Gums may appear shiny when the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue.

They may also emit an unpleasant odor.

Gums will bleed more easily with even gentle brushing, and especially when flossing.

The cause of plaque-induced gingivitis is bacterial plaque.

Plaque initiates the body’s host response.

Plaque leads to destruction of the gingival tissues, and may progress to destruction of the periodontal attachment apparatus.

The plaque accumulates in plaque traps, which are small gaps between teeth and in gingival grooves

These plaque traps accumulate and maintain plaque.

Other plaque traps include restorative margins, removable partial dentures and calculus that forms on teeth.

Bacteria in plaque accumulations produce chemicals, degradative enzymes, and toxins.

Chemicals such as lipopolysaccharide or lipoteichoic acid promote an inflammatory response in the gum tissue.

The inflammatory process can cause an enlargement of the gingiva.

Early plaque consists of bacterial community dominated by Gram-positive cocci and rods.

With plaque maturation and development of gingivitis the bacterial accumulation becomes increasingly complex with higher proportions of Gram-negative rods, fusiforms, filaments, spirilla and spirochetes.

Risk factors associated with gingivitis:



low dental care utilization

poor oral hygiene

overly aggressive oral hygiene such as brushing with stiff bristles

mouth-breathing during sleep

medications that dry the mouth

cigarette smoking

genetic factors

Gingivitis has no loss of bone but inflammation and bleeding are present.

Each tooth is divided into four gingival units (mesial, distal, buccal, and lingual).

Each tooth is gingival unit are given a score from 0-3 based on the gingival index.

The four scores are then averaged to give each tooth a single score.

Diagnosis is based on clinical assessment during a comprehensive periodontal exam.

A periodontal exam consists of a visual exam, 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.

The levels of the enzymes in saliva are associated with periodontal destruction and include: aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and acid phosphatase (ACP).

The above enzyme biomarkers may be used to aid in the diagnosis and treatment of gingivitis and periodontitis.

Can be prevented through regular oral hygiene that includes daily brushing and flossing, as well as the use of hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes.

Rigorous plaque control programs with periodontal scaling and curettage also have proved to be helpful.

Periodontal scaling and root planing are considered as a treatment for periodontal disease.

Toothpaste containing triclosan is effective in preventing gingivitis.

The focus of treatment of gingivitis is to remove plaque, to reduce oral bacteria and to have regular periodic visits to a dental professional and oral hygiene home care.

Methods used in the prevention of gingivitis can also be used for the treatment of gingivitis, such as scaling, root planing, curettage, mouth washes containing chlorhexidine or hydrogen peroxide, and flossing.

Interdental brushes also help remove any causative agents.

Powered toothbrushes work better than manual toothbrushes in reducing the disease.

The active ingredients that reduce plaque and demonstrate effective reduction of gingival inflammation over a period of time are triclosan, chlorhexidine digluconate, and a combination of thymol, menthol, eucalyptol, and methyl salicylate are found in toothpaste and mouthwash.

Hydrogen peroxide is a suitable over-the-counter agent to treat gingivitis and there is evidence of it controlling gingivitis in short-term use.

Gl oridated hydrogen peroxide-based mouth rinse can remove teeth stain and reduce gingivitis.

Mouthwashes with essential oils are also useful

The bacteria resulting in gingivitis can be controlled by using an oral irrigator daily with a mouthwash containing an antibiotic.

Oral hygiene care improves gingival health in individuals with type 2 diabetes.

Periodontitis is caused by microorganisms that adhere to and grow on the tooth’s surfaces, along with an over-aggressive immune response against these microorganisms.

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