Gingivitis#Treatment

File:Gingivitis.png

The symptoms of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation:

• 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)

File:Causes of Periodontal Disease (44846229684).jpg

Additionally, the stippling that normally exists in the gum tissue of some individuals will often disappear and the gums may appear shiny when the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. The accumulation may also emit an unpleasant odor. When the gingiva are swollen, the epithelial lining of the gingival crevice becomes ulcerated and the gums will bleed more easily with even gentle brushing, and especially when flossing.

• Recurrence of gingivitis
• Periodontitis
• Infection or abscess of the gingiva or the jaw bones
• Trench mouth (bacterial infection and ulceration of the gums)
• Swollen lymph nodes
• Associated with premature birth and low birth weight{{cite journal | vauthors = Saini R, Saini S, Saini SR | title = Periodontitis: A risk for delivery of premature labor and low-birth-weight infants | journal = Journal of Natural Science, Biology, and Medicine | volume = 1 | issue = 1 | pages = 40–42 | date = July 2010 | pmid = 22096335 | pmc = 3217279 | doi = 10.4103/0976-9668.71672 | doi-access = free }}

A study from 2018 found evidence that gingivitis bacteria may be linked to Alzheimer's disease. Scientists agree that more research is needed to prove a cause and effect link.{{Cite web|url=https://theconversation.com/alzheimers-is-linked-to-gum-disease-but-bad-oral-health-is-not-the-only-culprit-110649|title=Alzheimer's is linked to gum disease – but bad oral health is not the only culprit| vauthors = Singhrao SK |date=January 30, 2019|website=theconversation.com}} "Studies have also found that the bacteria P. gingivalis – which are responsible for many forms of gum disease – can migrate from the mouth to the brain in mice. And on entry to the brain, P. gingivalis can reproduce all of the characteristic features of Alzheimer's disease."{{cite journal | vauthors = Lee KH, Choi YY | title = Association between oral health and dementia in the elderly: a population-based study in Korea | journal = Scientific Reports | volume = 9 | issue = 1 | pages = 14407 | date = October 2019 | pmid = 31594986 | pmc = 6783535 | doi = 10.1038/s41598-019-50863-0 | bibcode = 2019NatSR...914407L }}

{{self-reference|Because plaque-induced gingivitis is by far the most common form of gingival diseases, the following sections will deal primarily with this condition.}}

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.{{cite journal | vauthors = ((Research, Science and Therapy Committee of the American Academy of Periodontology))| title = Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions | journal = Journal of Periodontology | volume = 72 | issue = 12 | pages = 1790–1800 | date = December 2001 | pmid = 11811516 | doi = 10.1902/jop.2001.72.12.1790 | doi-access = free }} The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that serve to 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.{{cite journal | vauthors = Kistler JO, Booth V, Bradshaw DJ, Wade WG | title = Bacterial community development in experimental gingivitis | journal = PLOS ONE | volume = 8 | issue = 8 | pages = e71227 | date = 14 August 2013 | pmid = 23967169 | pmc = 3743832 | doi = 10.1371/journal.pone.0071227 | doi-access = free | bibcode = 2013PLoSO...871227K }} Further study of these taxa is warranted and may lead to new therapeutic approaches to prevent periodontal disease including systemic health.

Risk factors associated with gingivitis include the following:

• age
• osteoporosis
• low dental care utilization
• poor oral hygiene
• overly aggressive oral hygiene such as brushing with stiff bristles
• mouth breathing during sleep
• orthodontic braces{{Cite web|date=2021-05-02|title=Gingivitis and braces|url=https://orthodonticsaustralia.org.au/gingivitis-and-braces/|access-date=2021-05-19|website=Orthodontics Australia|language=en-AU}}
• medications and conditions that dry the mouth
• cigarette smoking
• genetic factors
• stress
• mental health issues such as depression
• pre-existing conditions such as diabetes
• drinking{{cite journal | vauthors = Neff JA, Kelley ML, Walters ST, Cunningham TD, Paulson JF, Braitman AL, Brickhouse TH, Gunsolley JC, Darby ML, Lemaster MF, Vandersluis JP, Walsh MM, Bolen H | display-authors = 6 | title = Effectiveness of a Screening and Brief Intervention protocol for heavy drinkers in dental practice: A cluster-randomized trial | journal = Journal of Health Psychology | volume = 20 | issue = 12 | pages = 1534–1548 | date = December 2015 | pmid = 24423575 | doi = 10.1177/1359105313516660 | s2cid = 206711510 }}
• obesity.{{Cite thesis |title=비만과 치주염 및 치아우식증과의 연관성 | trans-title = Association between obesity, periodontitis and dental caries |url=https://s-space.snu.ac.kr/handle/10371/125223 |publisher=서울대학교 대학원 (Seoul National University Graduate School) |date=August 2014 |degree=Ph.D. |language=ko |vauthors = Kim E}}

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 done by a dentist. The diagnosis is based on clinical assessment data acquired during a comprehensive periodontal exam. Either a registered dental hygienist or a dentist may perform the comprehensive periodontal exam but the data interpretation and diagnosis are done by the dentist. The comprehensive 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.

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.

As defined by the 1999 World Workshop in Clinical Periodontics, there are two primary categories of gingival diseases, each with numerous subgroups:{{cite journal | vauthors = Armitage GC | title = Development of a classification system for periodontal diseases and conditions | journal = Annals of Periodontology | volume = 4 | issue = 1 | pages = 1–6 | date = December 1999 | pmid = 10863370 | doi = 10.1902/annals.1999.4.1.1 | url = http://perio.org/resources-products/classification.pdf | url-status = dead | access-date = 2010-05-12 | archive-url = https://web.archive.org/web/20100612231947/http://perio.org/resources-products/classification.pdf | archive-date = 2010-06-12 }}

1. Dental plaque-induced gingival diseases.
2. Gingivitis associated with plaque only
3. Gingival diseases modified by systemic factors
4. Gingival diseases modified by medications
5. Gingival diseases modified by malnutrition
6. Non-plaque-induced gingival lesions
7. Gingival diseases of specific bacterial origin
8. Gingival diseases of viral origin
9. Gingival diseases of fungal origin
10. Gingival diseases of genetic origin
11. Gingival manifestations of systemic conditions
12. Traumatic lesions
13. Foreign body reactions
14. Not otherwise specified

As defined by the 2017 World Workshop, periodontal health, gingival diseases/ conditions have been categorised into the following:{{cite journal | vauthors = Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS | display-authors = 6 | title = A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification | journal = Journal of Clinical Periodontology | volume = 45 Suppl 20 | issue = S20 | pages = S1–S8 | date = June 2018 | pmid = 29926489 | doi = 10.1111/jcpe.12935 | doi-access = free | hdl = 2027.42/144587 | hdl-access = free }}

1. Periodontal health and gingival health
2. Clinical gingival health on an intact periodontium
3. Clinical gingival health on a reduced periodontium
4. Stable periodontitis patient
5. Non-periodontitis patient
6. Gingivitis – dental biofilm-induced
7. Associated with dental biofilm alone
8. Mediated by systemic or local risk factors
9. Drug-influenced gingival enlargement
10. Gingival diseases – non-dental biofilm induced
11. Genetic/ developmental disorders
12. Specific infections
13. Inflammatory and immune conditions
14. Reactive processes
15. Neoplasms
16. Endocrine, nutritional & metabolic diseases
17. Traumatic lesions
18. Gingival pigmentation

Gingivitis can be prevented through regular oral hygiene{{Cite web|date=2021-05-02|title=How to Get Rid of Puffy Gums with Braces|url=https://orthodonticsaustralia.org.au/how-to-get-rid-of-puffy-gums-with-braces/|access-date=2021-07-21|website=Orthodontics Australia|language=en-AU}} that includes daily brushing and flossing.{{cite journal | vauthors = Sambunjak D, Nickerson JW, Poklepovic T, Johnson TM, Imai P, Tugwell P, Worthington HV | title = Flossing for the management of periodontal diseases and dental caries in adults | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD008829 | date = December 2011 | pmid = 22161438 | doi = 10.1002/14651858.CD008829.pub2 | veditors = Johnson TM | s2cid = 70702223 }} Hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes may also be employed. In a 2004 clinical study, the beneficial effect of hydrogen peroxide on gingivitis has been highlighted.{{cite journal | vauthors = Hasturk H, Nunn M, Warbington M, Van Dyke TE | title = Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: a randomized clinical trial | journal = Journal of Periodontology | volume = 75 | issue = 1 | pages = 57–65 | date = January 2004 | pmid = 15025217 | doi = 10.1902/jop.2004.75.1.57 }} The use of oscillation type brushes might reduce the risk of gingivitis compared to manual brushing.{{cite journal | vauthors = Deacon SA, Glenny AM, Deery C, Robinson PG, Heanue M, Walmsley AD, Shaw WC | title = Different powered toothbrushes for plaque control and gingival health | journal = The Cochrane Database of Systematic Reviews | volume = 2010 | issue = 12 | pages = CD004971 | date = December 2010 | pmid = 21154357 | pmc = 8406707 | doi = 10.1002/14651858.cd004971.pub2 }}

Rigorous plaque control programs along with periodontal scaling and curettage also have proved to be helpful, although according to the American Dental Association, periodontal scaling and root planing are considered as a treatment for periodontal disease, not as a preventive treatment for periodontal disease.{{cite web | url = http://www.adha.org/profissues/prophylaxis.htm | title = American Dental Hygienists' Association Position Paper on the Oral Prophylaxis | archive-url = https://web.archive.org/web/20120626084928/http://www.adha.org/profissues/prophylaxis.htm | archive-date=2012-06-26 | quote = Approved by the ADHA Board of Trustees April 29, 1998 }} In a 1997 review of effectiveness data, the U.S. Food and Drug Administration (FDA) found clear evidence showing that toothpaste containing triclosan was effective in preventing gingivitis.{{cite web | url = https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm | archive-url = https://web.archive.org/web/20100411202211/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm | url-status = dead | archive-date = April 11, 2010 | title = FDA Triclosan: What Consumers Should Know | access-date = 2010-08-12 | publisher = U.S. Food and Drug Administration }} In 2017 the FDA banned triclosan in many consumer products but allowed it to remain in toothpaste because of its effectiveness against gingivitis.{{cite web | vauthors = Kary T | date = 15 January 2019 | url = https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan | archive-url = https://web.archive.org/web/20190507072630/https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan | url-status = dead | archive-date = May 7, 2019 | title = FDA - 5 Things to Know About Triclosan | access-date = 2021-04-08 | work = U.S. Food and Drug Administration }} In 2019, Colgate, under pressure from health advocates, removed triclosan from the last toothpaste on the market containing it, Colgate Total.{{cite news | url = https://www.bloomberg.com/news/articles/2019-01-15/colgate-total-toothpaste-to-relaunch-this-time-sans-triclosan | work = Bloomberg | title = Colgate Total Toothpaste to Relaunch Without Controversial Chemical | date = 15 January 2019 | access-date = 2021-04-08 }}

File:Gingivitis-before-and-after-3.jpg of the teeth]]

File:Gum paint.jpg

The focus of treatment is to remove plaque. Therapy is aimed at the reduction of oral bacteria and may take the form of regular periodic visits to a dental professional together with adequate oral hygiene home care. Thus, several of the methods used in the prevention of gingivitis can also be used for the treatment of manifest gingivitis, such as scaling, root planing, curettage, mouth washes containing chlorhexidine or hydrogen peroxide, and flossing. Interdental brushes also help remove any causative agents.{{cite news |last1=Peter |first1=Josh |title=Gingivita |url=https://smilecare.ro/gingivita-semnele-aparitie/ |access-date=27 September 2023}}

Powered toothbrushes work better than manual toothbrushes in reducing the disease.{{cite journal | vauthors = Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM | title = Powered versus manual toothbrushing for oral health | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 6 | pages = CD002281 | date = June 2014 | pmid = 24934383 | pmc = 7133541 | doi = 10.1002/14651858.CD002281.pub3 }}

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. These ingredients are found in toothpaste and mouthwash. Hydrogen peroxide was long considered a suitable over-the-counter agent to treat gingivitis. There has been evidence to show the positive effect on controlling gingivitis in short-term use. A study indicates the fluoridated hydrogen peroxide-based mouth rinse can remove teeth stain and reduce gingivitis.

Based on a limited evidence, mouthwashes with essential oils may also be useful, as they contain ingredients with anti-inflammatory properties, such as thymol, menthol and eucalyptol.{{cite journal | vauthors = Stoeken JE, Paraskevas S, van der Weijden GA | title = The long-term effect of a mouthrinse containing essential oils on dental plaque and gingivitis: a systematic review | journal = Journal of Periodontology | volume = 78 | issue = 7 | pages = 1218–1228 | date = July 2007 | pmid = 17608576 | doi = 10.1902/jop.2007.060269 }}

The bacteria that causes gingivitis can be controlled by using an oral irrigator daily with a mouthwash containing an antibiotic. Either amoxicillin, cephalexin, or minocycline in 500 grams of a non-alcoholic fluoride mouthwash is an effective mixture.{{cite web | veditors = Brennan D | work = WebMD | url = http://www.webmd.com/oral-health/antibioticsantimicrobials-for-gum-disease | title = Treatments for Gum Disease | date = 29 January 2023 }}

Overall, intensive oral hygiene care has been shown to improve gingival health in individuals with well-controlled type 2 diabetes. Periodontal destruction is also slowed due to the extensive oral care. Intensive oral hygiene care (oral health education plus supra-gingival scaling) without any periodontal therapy improves gingival health, and may prevent progression of gingivitis in well-controlled diabetes.

{{Portal|Medicine}}

• Pericoronitis
• "Full width gingivitis" of orofacial granulomatosis
• Desquamative gingivitis

{{Reflist}}

{{Medical resources

| DiseasesDB = 34517

| ICD10 = {{ICD10|K|05|0|k|00}}-{{ICD10|K|05|1|k|00}}

| ICD9 = {{ICD9|523.0}}-{{ICD9|523.1}}

| ICDO =

| OMIM =

| MedlinePlus = 001056

| eMedicineSubj = article

| eMedicineTopic = 763801

| MeshID = D005891

| SNOMED CT = 66383009

}}

{{Periodontology}}

{{Oral pathology}}

{{Authority control}}

Category:Inflammations

Category:Periodontal disorders