GINGIVITIS - Disease Management

Gingivitis is an inflammatory process limited to the mucosal epithelial tissue surrounding the cervical a portion of the teeth and the alveolar processes. Gingivitis proceeds through an initial stage to produce early lesions, which then progress to advanced disease. The initial stage of an acute exudative inflammatory response begins within 4 or 5 days of plaque accumulation. Both gingival fluid and transmigration of neutrophils increase. At approximately 1 week, the transition to early lesions is marked by the change to predominately lymphocytic infiltrates. With time, lesions become chronic and are characterized by the presence of plasma cells and B lymphocytes. As chronic local inflammation progresses, pockets develop where the gingiva separates from the tooth. These pockets deepen and may bleed during tooth brushing, flossing, and even normal chewing. As this persistent inflammation continues, periodontal ligaments break down and destruction of the local alveolar bone occurs. Teeth loosen and eventually fall out.

Classification

Gingivitis has been classified on the basis of:

Clinical appearance:-

• Ulcerative
• Hemorrhagic
• Necrotizing
• Purulent

Etiology:-

• Drug-induced
• Hormonal
• Nutritional
• Infectious
• Plaque-induced

Duration:-

• Acute
• Chronic
• Causes
• Bacteria
• Inadequate oral hygiene
• Inadequate plaque removal
• Blood dyscrasias
• Allergic reactions
• Chronic debilitating disease

Drug-induced causes:-

• .Gingival bleeding -Anticoagulants and fibrinolytic agents.
• Gingival hyperplasia Phenytoin, oral contraceptive agents, calcium channel blockers
• Gingivitis - Protease inhibitors (eg, saquinavir, ritonavir), vitamin A and analogues, danazol, pentamidine, misoprostol, methotrexate, and gold compounds
• Gingivostomatitis- Exposure to arsenic, gold, bismuth, mercury, nickel, sulfur dioxide, lead, thallium, zinc, methyl violet, and topical chlorhexidine.

Risk Factors

• Use of tobacco or ethanol
• Immune incompetence
• Diabetes mellitus
• Malocclusion
• Poor dental hygiene
• Faulty dental restoration

Signs and Symptoms

.Chronic gingivitis:-

• Bleeding gums while toothbrushing, flossing, and eating

Acute necrotizing ulcerative gingivitis:-

• Apparently spontaneous bleeding or bleeding in response to very minimal local trauma
• Local pain, malaise, and alterations in taste, such as a metallic flavobr.
• .Foul breath
• Erythema, edema, tenderness, and induration of affected areas

DIAGNOSIS

Differential Diagnosis:-

• Adrenal insufficiency and Adrenal crisis
• HIV
• Pericoronitis

Investigations:-

• Smear to identify causative agents

Pharmacological treatment

Classes of drugs used are:-

Antibiotics:-

• Amoxicillin/Clavulanate
• Erythromycin
• Penicillin V
• Metronidazole
• Tinidazole

Antiseptic

Analgesics

Topical anesthetics

PATIENT EDUCATION

• Good oral hygiene
• Regular dental check-ups

Complications

• Local and systemic complications
• Noma
• Periodontal disease and tooth loss
• Osteomyelitis of alveolar bone.

Prognosis

• Untreated chronic gingivitis eventually results in tooth loss. After initial cleaning and scaling in its early stages, gingivitis usually is reversible with good dental hygiene.

• Gingivitis generally responds well to appropriate treatment.