Gingivitis is the medical term for inflammation of the gums (gingiva), which is a mild form of gum disease, usually caused by a bacterial infection as a result of plaque formation.
Types of Gingivitis
Gingivitis may be of two types, depending upon the severity of the condition.
Chronic gingivitis is the more common type of gingivitis and is closely linked to inadequate oral hygiene. In most cases, a person is unaware that they have chronic gingivitis and do not seek medical treatment until the symptoms become pronounced.
Slight bleeding and mild swelling of the gums are the first signs and symptoms. If attended to in the early stages, gingivitis may be totally reversible with simple measures such as brushing, flossing and cleaning.
Acute Necrotizing Ulcerative Gingivitis (ANUG)
The other form of gingivitis is known as acute necrotizing ulcerative gingivitis (ANUG), Vincent’s stomatitis, or trench mouth. It is rarely seen these days.
ANUG is more likely to develop in a person with an impaired immune system or in those with severe malnutrition. This is a more acute and invasive form of gingivitis which may cause foul-smelling breath (halitosis), fever and painful gums in addition to other symptoms.
ANUG may develop in people with a history of gingivitis who experience a stressful event and is more common in smokers than in non-smokers.
Causes and Risks of Gingivitis
- Gingivitis is most commonly caused by long-term effects of plaque deposition, usually due to inadequate oral hygiene.
- Gum injury due to any cause. This may include extremely vigorous brushing or flossing.
- Gum irritation caused by misaligned teeth, ill-fitting crowns, dentures, bridges, and braces, or rough edges of fillings. These may also contribute to plaque deposition and difficulty in plaque removal.
- Many types of medication have been associated with gingivitis, including contraceptive pills, phenytoin (drug to control seizures), and heavy metals such as bismuth and lead.
- Hormonal changes during pregnancy and menopause.
- Immuno-compromised conditions, as in AIDS or cancer.
- Gingivitis may be the first sign of disease in about 25% of children suffering from leukemia.
- Chronic debilitating disease.
- Uncontrolled diabetes.
- Habits such as smoking or chewing tobacco.
- Severe malnutrition and vitamin deficiencies can cause gingivitis. Examples – scurvy (due to vitamin C deficiency) and pellagra (due to niacin deficiency).
- Gingivitis due to viral infections, such as acute herpetic gingivostomatitis caused by herpes virus.
- Fungal infections may cause gingivitis by overgrowth of fungi, such as Candida albicans in the mouth, resulting in candidiasis or thrush.
- Gingivitis may occur in the gums surrounding the crown of an impacted tooth (a tooth that has not fully erupted). This condition, called pericoronitis, occurs more frequently with the wisdom teeth.
- Blood dyscrasias.
- Allergic reactions.
Pathophysiology of Gingivitis
Less than adequate oral hygiene forms the basis of almost all types of gingivitis, compounded with bacterial invasion. Even after removal by brushing, plaque usually forms again within 24 hours. Plaque build-up can be avoided by brushing and flossing regularly.
Plaque remaining on the teeth for more than 2 or 3 days can harden under the gum line and form tartar, which is more difficult to remove. The marginal gingiva is involved in most types of gingivitis, where there is accumulation of microbial plaques.
Within 4 to 5 days of plaque accumulation there is an acute inflammatory response which causes an increase in gingival fluid and neutrophils. Fibrin deposition and collagen destruction occurs at this stage. Lymohocytic infiltration occurs in about a week’s time leading to formation of lesions. An increase in monocytes and plasma cells may be noted at this time.
Without treatment, the lesions may become chronic. Plasma cells and B lymphocytes will be present at this stage. With further progression of the condition, pockets are formed between the gums and the teeth. These pockets cause separation of the tooth from the gums and may bleed while brushing or flossing. With time, the ligaments and bone supporting the tooth are gradually destroyed.
If still left untreated, the tooth will ultimately fall out.
In case of ANUG, there is more acute involvement of tissues. Local tissue destruction is more rapid, along with local and systemic spread of infection. ANUG may be caused by organisms such as Prevotella intermedia, alpha-hemolytic Streptococci, Actinomyces species, or different types of oral Spirochetes.
Symptoms of Chronic Gingivitis
- Red, swollen gums
- Gums may be tender to touch
- Gums that bleed easily on brushing or flossing
- Chronic bad breath
- Sensitive teeth
Symptoms of ANUG
- Infected, painful gums
- Bleeding gums, even on the slightest touch
- Redness and swelling of gums
- A whitish or grey film (pseudomembrane) over the gums
- Mouth sores
- Halitosis or bad breath
- Bad taste in the mouth
- Pain during biting or swallowing
- Generalized weakness
- Lymph node swelling of the head, neck or jaw