Gingivitis

By: Maryam Arbab

Contents1. Classification

2. Clinical Features

3. Aetiology

4. Management

CLASSIFICATION OF GINGIVITIS

Course Based Classification

Distribution Based Classification

Classification according to Course

1. ACUTE GINGIVITIS :– It is of sudden onset and short duration and can be painful.– A less severe form of acute condition is called SUBACUTE.

2. RECURRENT GINGIVITIS :– Reappears after eliminated by treatment or disappearing

spontaneously.

3. CHRONIC GINGIVITIS :– Slow in onset and of long duration, and is painless, inflammation

persists or resolves and normal areas become inflamed.

Classification according to DISTRIBUTION

1. LOCALIZED GINGIVITIS :

Confined to gingiva of single tooth.

a) LOCALIZED MARGINAL GINGIVITIS :• Confined to one or more areas of the marginal gingiva.

b) LOCALIZED DIFFUSE GINGIVITIS :• Extends from margin to the mucobuccal fold but is limited in

area.

c) LOCALIZED PAPILLARY GINGIVITIS :• Confined to one or more interdental spaces in a limited area.

LOCALIZED PAPILLARY GINGIVITIS

Cont..

2. GENERALIZED GINGIVITIS

Involves the entire mouth.

a) GENERALIZED MARGINAL GINGIVITIS :• Involves gingival margins in relation to all teeth.• The interdental papillae are usually affected in generalized

marginal gingivitis.

b) GENERALIZED DIFFUSE GINGIVITIS :• Involves the entire gingiva.• The alveolar mucosa and attached gingiva are affected.• May be caused by systemic conditions.

MARGINAL GINGIVITIS

LOCALIZED GENERALIZED

Section 2 : Clinical Features

CLINICAL FINDINGS

A systemic clinical approach requires an orderly examination of the gingiva for :

Color Contour Consistency Position Ease and Severity of bleeding Pain

GINGIVAL BLEEDING ON PROBING

Bleeding on probing is easily detectable clinically and is of value for the early diagnosis and prevention of more advanced gingivitis.

Appears earlier than a change in color or other visual signs of inflammation.

COLOR CHANGES IN GINGIVITIS

1. The color changes may be marginal, diffuse, or patch like depending on the underlying condition.

2. Color changes vary with the intensity of the inflammation. Initially, it is red erythema.

Cont..

3. In severe inflammation, the red color gradually becomes dull, whitish gray

4. Many systemic diseases may cause color changes in the oral mucosa, including the gingiva.

5. The deposition of iron in hemochromatosis may produce a bluish-gray pigmentation of the oral mucosa. In jaundice, the oral mucosa acquires a yellowish color.

CHRONIC GENERALIZED GINGIVITIS

CHANGES IN THE CONSISTENCY OF THE GINGIVA

1. Both chronic and acute inflammation produce changes in the normal firm, resilient consistency of gingiva.

2. In chronic gingivitis, both destructive (edematous) and reparative (fibrotic) changes coexist.

3. The consistency of gingiva is determined by their relative predominance.

CHANGES IN THE POSITION OF THE GINGIVA

RECESSION :• The exposure of the root surface by an apical shift in the

position of the gingiva.• Recession refers to the location of the gingiva, not its

condition.• Recession may be localized to one tooth or a group of

teeth, or it may be generalized through-out the mouth.

A. ACTUAL POSITION OF THE GINGIVA :• The level of epithelial attachment on the tooth.

CHANGES IN THE POSITION OF THE GINGIVA

B. APPARENT POSITION OF THE GINGIVA :

• The level of crest of the gingival margin. The severity of recession is determined by actual position of gingiva, not its apparent position.\

The two types of recession are :a. VISIBLE : Clinically observable.b. HIDDEN : Covered by gingiva and can

be measured by inserting a probe to the level epithelial attachment.

CHANGES IN GINGIVAL CONTOUR

1. STILLMAN’S CLEFTS :– Apostrophe -shaped

indentation of the gingival margin.

2. McCALL FESTOON :– Life preserver- shaped

enlargement of the margin.

ETIOLOGY: Trauma from occlusion. They represent peculiar inflammatory changes of the marginal gingiva

CHANGES IN SURFACE TEXTURE OF THE GINGIVA

1. Loss of surface stippling is an early sign of gingivitis.

2. In chronic inflammation the surface is either smooth and shiny or nodular, depending on whether the dominant changes are exudative or fibrotic.

Aetiology

Causes & Risk Factors

• Some people are more prone to getting gingivitis than others.• Gingivitis is particularly likely to occur in people with diabetes, AIDS, or

leukemia. • Other factors linked to an elevated risk of gingivitis include:

– puberty– pregnancy– menopause– smoking– poor-fitting fillings and crowns (also known as caps)– mouth breathing– genetics– allergic reaction (e.g., cinnamon gum)– vitamin C deficiency (scurvy)– niacin (vitamin B3) deficiency (pellagra)– poorly aligned teeth or poorly fitted mouth appliances (such as retainers or crowns)– medications (e.g., use of the female contraceptive pill)

Cont..

• Some medications are also associated with gingivitis, including:– cyclosporine* (used to treat rheumatoid arthritis and

other autoimmune diseases)– phenytoin (used to control epilepsy and other seizures)– calcium channel blockers such as nifedipine (used treat

high blood pressure and other heart conditions)– Some viruses can also infect the mouth. The one most

likely to attack the gums is the herpes virus.

Management

• Signs and Symptoms

• Investigations/Diagnosis

• Treatment

• Prevention

• Complications

Signs and Symptoms

• Red, swollen gums.

• Gums may or may not be painful.

• Gums may bleed when brush or floss your teeth.

• Halitosis (bad breath) is worse if have gingivitis.

Diagnoses of Gingivits

• Dentist will check gums for swelling and redness.

• Dentist will also use a dental probe (metal tool) to check for bleeding.

• X-rays (pictures) may be taken of your mouth and teeth.

Prevention is better than Cure

• Brush teeth two times a day after meals with fluoride toothpaste

• Use dental floss to clean between teeth at least once a day

• Ask dentist if should use a dental rinse, and what kind may work best

• See dentist regularly. Ask dentist how often should see him for dental cleanings and exams

Cont..

• Floss teeth every day.

• Use a special dental rinse. These special rinses may help to reduce plaque and decrease swelling of gums.

• Stop smoking. Smoking increases risk of getting periodontitis, which can occur if gingivitis gets worse. Smoking also decreases how well treatments for gum disease work.

Conclusion

• The conclusion is very important to maintain the healthy teeth and beautiful smile

• Prevent plaque from appearing at the gums and teeth that will cause gingivitis or periodontitis

• Brushing and flushing are very important to prevent any formation of the hard plaque ,infection and inflammation for a good and healthy mouth

THANK YOU!!