Gingivitis

Definition/diagnostic criteria

Gingivitis is defined as the inflammation of the gingiva or gums, which is most commonly a result of dental plaque accumulation. The condition is characterized by redness, swelling, and bleeding of the gums, especially during brushing or flossing. Gingivitis is reversible with appropriate oral hygiene measures. Chronic gingivitis may lead to periodontitis, a more serious condition affecting the periodontium and potentially leading to tooth loss.

Epidemiology

Gingivitis is a highly prevalent condition worldwide and affects a significant portion of the UK population. It is observed across all age groups but is more prevalent in adults due to cumulative exposure to risk factors. Various studies suggest that mild to moderate forms of gingivitis are nearly universal.

Diagnosis

Clinical features

The diagnosis of gingivitis is primarily clinical, based on the observation of the signs and symptoms of gingival inflammation. Common features include:

• Red and swollen gums
• Bleeding gums during brushing, flossing, or spontaneously
• Tender gums
• Bad breath or halitosis may also be present

Investigations

These should be the remit of the dentist. Diagnostic investigations primarily aim to rule out periodontitis and identify possible systemic conditions contributing to gingival inflammation. These include:

• Dental X-rays to assess bone loss around the teeth
• Periodontal probing to measure the depth of the gingival sulcus, with depths greater than 3mm suggesting periodontitis
• Blood tests if systemic conditions are suspected

Typical abnormalities found in gingivitis include increased probing depth due to swollen gums but without the attachment loss characteristic of periodontitis.

Treatment

Treatment of gingivitis focuses on plaque removal and controlling the inflammation. This involves:

• Oral hygiene education, emphasizing the importance of brushing twice a day with fluoride toothpaste and daily flossing.
• Professional dental cleaning to remove plaque and tartar (calculus).
• Antiseptic mouthwash may be recommended for short-term use to reduce bacterial load, but it is not a substitute for mechanical plaque removal.

Prognosis

With adequate oral hygiene practices, the prognosis for gingivitis is excellent. The condition is reversible, and gum health can be fully restored. Failure to treat gingivitis, however, can lead to periodontitis, which can cause irreversible damage to the supporting structures of the teeth and tooth loss.