Home > Encyclopedia of Nursing & Allied Health > Gingivitis

Definition

Gingivitis is a disorder involving inflammation of the gingiva (gum tissue). It is sometimes called gum disease.

Description

Periodontal disease is a worldwide problem. This mildest form of periodontal disease, gingivitis, is inflammation strictly limited to the gingiva and does not manifest changes in the underlying bone. When bony changes become evident, the condition is termed periodontitis.

There is commonly little or no discomfort with gingivitis. The only people who escape gingivitis are very young infants; otherwise, it affects all age groups and people of all ethnic and racial backgrounds. A bacterial infection of the gums, it causes the gum tissues to turn red and swollen. Mild gingivitis causes little pain, and may be overlooked by the dentist; however, if left unchecked, it can turn into severe gingivitis. Many people experience varying degrees of gingivitis throughout their lives, but overlook it. It commonly develops during puberty or in early adulthood, and may persist or recur frequently.

In studies cited by the American Academy of Periodontology (AAP) in Boston, Massachusetts, 1,259 patients between the ages of 13 and 65 were studied. Of those 1,259 between ages 13 and 15, 80% had some form of gingivitis, while 95% had gingivitis at age 60. Males were more frequently affected than females, with the overall average being 88% and 80%, respectively.

Causes and symptoms

The etiology of gingivitis is especially varied and has been divided into local and systemic factors.

Local factors

• microorganisms
• food impaction
• faulty or irritating restorative orthodontic appliances
• breathing through the mouth, rather than the nose
• tooth malposition
• chemical or drug application

Microorganisms are the bacteria found in plaque. The bacteria that destroy living tissue release many destructive enzymes. Specific microorganisms sometimes cause inflammatory reactions in the gingiva. Streptococcal and Staphylococcal are the bacteria known to destroy tissue and cause inflammation.

Food impaction, or general oral neglect, is the most common cause of gingivitis. The food impacts around the teeth and accumulation of debris on the teeth causes irritation of the gingiva by the toxins in the plaque. The byproducts of the toxins cause swelling of the tissue and redness to occur.

Faulty or irritating restoration, or appliances, may act as irritants to the gum tissue and thus induce gingivitis. Overhanging margins on dental fillings may directly irritate the gingiva and cause food to become impacted; this further adds to making the gum tissue even more tender. When prosthetic or orthodontic appliances encroach on the gingival tissues, gingivitis may occur—the result of the pressure and the trapping of food and bacteria. The tissue may become inflamed, redden, and become painful to the touch.

Mouth breathing (not breathing through the nose) causes drying of the oral mucous membrane and irritates the gum tissue, causing inflammation and hyperplasia of the tissue.

Tooth malposition results in repeated abnormal forces during the eating and chewing of food. Calculus may be deposited on the surface of the tooth that has no force to aid in keeping it clean. Bacteria may begin to attack the tissue around the tooth, resulting in a combination of inflammation and gum recession.

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KEY TERMS

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Calculus—A hard deposit that forms on the teeth, also known as hardened plaque and tartar.

Edematous—An abnormal accumulation of serous fluid in the tissues.

Gingiva—The gum tissue.

Gum recession—The gum tissue backing away from the crown of tooth towards the root.

Hyperemia—Swelling of the gum tissue.

Local—Pertaining to or being in one particular place.

Systemic—Pertaining to, or affecting the whole body.

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Chemical or drug application may cause many gum tissue anomalies. A number of drugs are at least potentially capable of inducing gingivitis. Over-the-counter (OTC) drugs can be harmful to the gum tissue and act as an acid burn if used. Silver nitrate and general aspirin have acidic affects on the gum tissue, causing redness and tenderness to the touch. Dilantin sodium produces swelling of the gum tissue due to the chemicals in the drug.

Systemic factors

• nutritional disturbances
• pregnancy
• diabetes and other conditions that cause endocrine dysfunction

Nutritional disturbances can create imbalances in the body system that effect changes in the gum tissue. Insufficient vitamin C may cause redness and swelling, along with tenderness. The inadequate intake, absorption, and utilization of some other vitamins, minerals, and food can affect the gum tissue, causing swelling and redness.

Pregnancy gingivitis refers to the changes the gingiva undergoes during pregnancy. The clinical appearance of the gingiva in pregnant women may vary—from no change to a smooth, shiny, deeply reddened, marginal gingival hyperemia (swelling of the gum tissue) of the papilla on the upper roof of the mouth. Gingivitis commonly appears at the end of the first trimester of pregnancy, and may remit or even completely disappear at the termination of the pregnancy.

Diabetes mellitus is also associated with severe periodontal disease. Uncontrolled diabetes can cause a metabolic change in the gum tissue and decrease an individual's resistance to infection.

Endocrine dysfunctions during puberty may lead to changes in the gum tissue (puberty gingivitis). The gingiva appears hyperemic (having an excess of blood) and edematous (swollen). Most studies have revealed that the main cause of these changes in the gingiva is caused by breathing through the mouth.

Diagnosis

A patient may have gingivitis and periodontitis in different parts of the mouth at the same time. A general dentist can examine the patient and look for calculus deposits on the teeth and under the gum line. A dental explorer or a cleaning instrument will then be used by the dentist to probe the gum tissue or to check for plaque buildup. Commonly, the practitioner will ask the patient if the gums bleed while flossing and brushing. The dentist needs to be made aware of any medications being taken that might be a causative factor in the gingivitis. Information provided by the patient may lead to a gingivitis diagnosis.

Treatment

The goal of treating gingivitis is for reduction of the gingival inflammation. The general dentist, or registered dental hygienist (RDH) commonly cleans the teeth. This may involve the use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Gingivitis is reversible with professional treatment and good home oral hygiene care. Changing toothbrushes every three months commonly improves dental hygiene in eliminating the bacteria in the mouth. Increased intake of vitamin C may aid in the development of healthy gum tissue. It is strongly recommended that strict oral hygiene be maintained for one's lifetime, or gingivitis will probably recur.

Prognosis

The prognosis for gingivitis is excellent. Once a program of good dental hygiene, such as proper toothbrushing and frequent prophylaxis (cleaning) is implemented, the symptoms of gingivitis will begin to disappear; this can happen in as little as one week. If there is poor response to good local therapy, a search should be made for systemic factors, which might be complicating the case.

Regular dental cleanings and exams are recommended at least every six to twelve months.

Health care team roles

An RDH is usually the first person seen by the patient when a cleaning is scheduled. The RDH role is to inform the patient of the condition of the gum tissues and consult with the general dentist about the treatment plan. After evaluating the case, ways to improve oral hygiene or to identify the irritant causing the gingivitis—such as a popcorn kernel, seed, or tartar buildup—will be suggested. Removal will then by done by the dentist.

Proper brushing and flossing is usually demonstrated by the RDH. This will aid in the maintenance of oral hygiene. The front desk receptionist may be responsible for keeping track of the recall records and following up with patients, by phone, who need appointment every six months.

Prevention

Prevention of gingivitis is simple and easy. Proper brushing techniques and proper flossing to remove any irritants or bacteria helps to stop gingivitis from growing. Regular dental checkups and cleanings will aid in reducing the risk of gingivitis.

For people who are prone to gingivitis, it may be recommended that they brush and floss after every meal, and at bedtime. Electric toothbrushes may be recommended for patients who have problems with strength or dexterity of their hands. Special appliances or tools, such as toothpicks, special toothbrushes, and water irrigation devices may be recommended for patients who are particularly prone to plaque deposits. These supplements do not replace brushing and flossing, but are enhancements in the prevention of gingivitis.

Cindy F. Ovard, R.D.A