Overview
Gingivitis describes the inflammation of gum tissue without tissue damage. Necrotising gingivitis may occur, which can result in significant pain and haemorrhage. Gingivitis usually occurs due to poor dental hygiene.
Periodontal disease describes the inflammation of the tissues surrounding the teeth, often causing irreversible tissue damage. Over time, the gingiva can detach, resulting in a pocket around the tooth and gum. Over time, the tooth may slowly loosen and fall out.
Dental plaque is a bacterial biofilm that forms on the surface of teeth that can be removed by brushing. Over time, it can calcify and form calculus, which is firmly stuck to the teeth and can only be removed by a dentist with specific equipment.
Epidemiology
- Plaque and periodontal inflammation are very common
- Around 50% of people in the UK have some degree of irreversible periodontitis
Risk Factors
Genera risk factors include:
- Poor dental hygiene
- Smoking – impairs gingival blood flow and wound healing
- Immunocompromised states – including HIV and immunosuppressant drugs
- Diabetes mellitus – due to altered inflammation and immune responses
- Dental factors – tooth position, dentures etc.
- Dry mouth and its causes (e.g. antidepressants, antihistamines etc.)
- Advancing age
- Pregnancy – the severity of gingivitis can increase in pregnancy
Presentation
Features of gingivitis include:
- Gum margin erythema and swelling
- Bleeding gums when brushing, flossing, pressure, and eating hard foods
- No gum discomfort, no systemic upset (e.g. fever, malaise, lymphadenopathy)
Features of necrotising gingivitis can include:
- Severe pain
- Bleeding becomes more easily triggered
- A pseudomembrane may be present
- Halitosis and necrotic odour
Management
Overview
If gingivitis, periodontitis, or acute necrotising gingivitis is suspected, refer to a dentist to confirm the diagnosis. Management may entail:
- Simple gingivitis: regular follow-up by a dentist
- Acute necrotising gingivitis: while referring to a dentist, oral metronidazole or amoxicillin may be given, along with chlorhexidine, and simple analgesia
