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Gingivitis and periodontitis

Author: Brian Wu PhD. MD Candidate, Keck School of Medicine, Los Angeles, USA; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, November 2015.

Gingivitis and periodontitis — codes and concepts

What are gingivitis and periodontitis?

The gingiva are the gums, the visible mucosa around teeth. Gingivitis refers to inflammation of the gingiva, and is common. It is a mild form of periodontitis, which means inflammation of all the tissues surrounding the teeth, and is less common.

Periodontitis is a chronic, inflammatory disease affecting the gingiva, ligaments and the underlying alveolar bone. Periodontitis can lead to soft tissue damage as well as loss of teeth and destruction of the bone.

What are the signs and symptoms of gingivitis and periodontitis?

Patients with gingivitis present with:

  • Puffy, dusky red, swollen gums
  • Gums which are tender and bleed easily
  • Foul breath

Patients with the more advanced periodontitis may present with:

  • Swollen, tender, receding bright red or purplish gums
  • New spaces between the teeth
  • Foul breath
  • Pus between the teeth and the gums
  • Loose teeth

What are the causes of gingivitis and periodontitis?

The main causes of gingivitis are:

  • Poor oral hygiene, which leads to the build-up of plaque. If teeth are not cared for properly, plaque hardens into tartar and irritates the gingiva
  • Systemic disorders like diabetes or leukaemia, exposure to heavy metals, pellagra (niacin deficiency) and scurvy (Vitamin C deficiency)
  • Skin disease, particularly erosive lichen planus

The build-up of tartar leads to periodontitis. The tartar irritates the gingiva and forms pockets that fill with bacteria, plaque and tartar. Subsequent infection can be serious.

Who gets gingivitis and periodontitis?

Risk factors for gingivitis and periodontitis include:

  • Hereditary factors
  • Poor or inadequate oral hygiene practices
  • Tobacco use
  • Immune compromise
  • Viral and yeast infections
  • Dry mouth
  • Hormonal changes associated with menses and pregnancy
  • Poor nutrition
  • Substance abuse
  • Ill-fitting dental restoration
  • Type 1 diabetes, leukaemia, Down syndrome, Papillon-Lefevre syndrome and Crohn disease.

What are the complications of gingivitis and periodontitis?

The largest complication of untreated gingivitis is periodontitis. Complications stemming from periodontist include:

  • Tooth loss
  • Increased risk for coronary artery disease
  • Increased risk for diabetes
  • Increased risk for respiratory diseases like asthma
  • Increased risk for rheumatoid arthritis

The link between periodontitis and increased risk of these serious chronic conditions is not fully understood.

How are gingivitis and periodontitis diagnosed?

Diagnosis for gingivitis and periodontitis is based upon thorough examination of the patient’s mouth, including cheeks, gums, and tongue. Probes may be used to examine gingival pockets.

X-rays may also be taken to evaluate possible damage to underlying bone structures.

How are gingivitis and periodontitis treated?

Treatment for gingivitis includes:

  • Thorough teeth cleaning (descaling) to remove plaque and tartar
  • At-home care includes brushing at least twice a day with a soft-bristled brush, use of mouthwash and dental floss
  • Regular dental checkups
  • Treatment of underlying conditions

Additional treatment for periodontitis includes:

  • Root planning to remove build-up from the roots of the teeth
  • Oral antibiotics to treat infection
  • Flap surgery
  • Soft tissue grafts
  • Bone grafts
  • Guided tissue restoration

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