Gingivitis

Introduction

Gingivitis refers to inflammation of the gingival tissue.

  • It is most commonly caused by bacterial infection due to excess plaque buildup on the teeth.
  • Importantly, the condition is entirely preventable with regular and correct toothbrushing.

Gingivitis



Aetiology

After toothbrushing, teeth are soon coated with a mixture of saliva and gingival fluid, known as the pellicle.

  • Oral bacteria and food particles adhere to this coating and begin to proliferate, forming plaque.

Routine brushing removes plaque, however, if plaque is allowed to build up for 3 or 4 days, bacteria begin to undergo internal calcification, producing calcium phosphate, better known as tartar (or calculus).

  • This adheres tightly to tooth surfaces and retains bacteria in situ.
  • The bacteria release enzymes and toxins that invade the gingival mucosa, causing inflammation of the gingiva (gingivitis).
If the plaque is not removed, the inflammation spreads downwards, involving the periodontal ligament and associated tooth structures (periodontitis).

  • A pocket forms between the tooth and gum, and over a period of years, the root of the tooth and bone are eroded until the tooth becomes loose and is lost.



Referral Indicators

Gingivitis is usually painless and rarely causes spontaneous bleeding.

However, certain findings warrant referral:

  • Foul taste associated with gum bleeding - suspect periodontitis
  • Signs of bleeding and bruising beyond gum - suspect sinister pathology (e.g. platelet disorders), require urgent same-day referral



Management

Prevention of plaque buildup is the key to healthy gums and teeth.

  • Twice-daily brushing for 2 minutes with a fluoride toothpaste is recommended to maintain oral hygiene and prevent tooth decay.
  • Daily interdental cleaning with floss or interdental brushes has also been shown to be more effective than toothbrushing alone.
  • Attend regular dental visits for professional cleaning (i.e. scaling and root planning), usually every 6 to 12 months.

Mouthwashes contain chlorhexidine, hexetidine and hydrogen peroxide.

  • Of these, chlorhexidine has high-quality evidence for reducing dental plaque and gingivitis regardless of its concentration.
    • Although chlorhexidine is free from side effects, patients should be warned that prolonged use (>4 weeks) may stain the tongue and brown the teeth. This can be reduced or removed by brushing the teeth before use. If this fails to remove the staining, it can be removed by a dentist.
  • They are rinsed around the mouth for 30 to 60 seconds and spat out.

Advise smoking cessation to improve treatment outcomes and periodontal stability.



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