Gingivitis (also known as gum disease) is a non-destructive periodontal disease. Gingivitis is an inflammation of the gum tissue as a response to bacterial plaque that adheres to tooth surfaces.
In the absence of treatment, gingivitis may progress to periodontitis, which is a destructive form of periodontal disease affecting the periodontal ligament and the alveolar bone.
Gingivitis is reversible with good oral hygiene. However, in the absence of treatment, or if not controlled, gingivitis can progress to periodontitis, where the inflammation results in tissue destruction and alveolar bone resorption, which can ultimately lead to tooth loss.
Signs and symptoms
The symptoms of gingivitis are somewhat non-specific and manifest in the gum tissue as the classic signs of inflammation.
- 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
a severe case of gingivitis
The most important risk factors associated with gingivitis are poor oral hygiene and low dental care, smoking and some pre-existing conditions such as diabetes.
The prevalence of gingivitis and periodontitis is higher in patients with diabetes, compared to those without diabetes and the symptoms are also more severe.
Another preventive method may take the form of regular visits to a dental professional. Several of the methods used in the prevention can also be used for the treatment of periodontal disease (especially in the early phase).
These methods may include scaling (or the removal of dental plaque and tartar), root planing, curettage or irrigation with various antiseptic substances.
The focus of treatment for gingivitis is removal of the etiologic (causative) agent : the bacterial plaque.
Oral hygiene therapy
The first goal is to increase patients motivation and to teach patients the proper techniques to remove bacteria from their teeth and gingiva. Patients are taught how to brush properly and advised to floss at least once daily.
Scaling and root planing
A patient's oral hygiene care at home must be combined with regular periodontal therapy at the dental office to remove dental plaque and calculus.
Dental plaque is the most important causative agent, while calculus (also known as tartar) is a form of hardened dental plaque, which threatens the health of the gingiva as well.
Scaling and root planing is the process of removing calculus and dental plaque using hand, sonic or ultrasonic instruments. The process is performed by the dentist or oral hygienist at the dental office.
scaling using a hand instrument
It is important to remove both the supragingival (located above the gumline) and the subgingival (located bellow the gumline) calculus. Normally, ultrasonic scalers provide deep cleaning above and below the gum line.
The teeth are polished to remove the remaining dental plaque and possible stains on the tooth surface. The polish contains an abrasive substance and fluoride, and is applied using a small rotating rubber cup or brush attached to the dental hand piece.
Irrigations and mouthwash
Various antiseptic ingredients have the ability to reduce plaque and demonstrate an effective reduction of gingival inflammation. Some examples : triclosan, chlorhexidine, menthol, eucalyptol and others.
These ingredients are found in toothpaste, mouthwash or irrigating solutions and are recommended to patients based upon their needs.
Evaluation and maintenance
The gingival tissue must be evaluated at subsequent dental appointments to keep the diagnosis current. Both in-office treatment and home care must be modified as necessary based on the re-evaluation.
If a treatment has been successfully completed, an ongoing maintenance is required. This involves regular checkups and an impeccable oral hygiene. If oral hygiene is improper, recurrence of gingivitis is very probable.
In the absence of treatment, gingivitis may progress to periodontitis.