Gingivitis

Gingivitis is a reversible inflammatory condition affecting the gingival tissues surrounding the teeth, primarily caused by accumulation of bacterial dental plaque along the gingival margin. Inflammatory changes may develop within a few days of undisturbed plaque formation on erupted teeth within the oral cavity.

If untreated, gingivitis may progress to periodontitis resulting in irreversible periodontal tissue destruction and tooth loss.

Etiology

Gingivitis commonly results from:

• Dental plaque accumulation

• Poor oral hygiene

• Calculus (tartar) deposition

• Food impaction

• Hormonal changes (pregnancy, puberty)

• Smoking and tobacco use

• Systemic diseases such as diabetes mellitus

• Certain medications (phenytoin, calcium channel blockers)

• Vitamin deficiencies

• Mouth breathing

• Ill-fitting dental appliances

Risk Factors

• Inadequate tooth brushing

• Lack of dental flossing

• Malnutrition

• Immunosuppression

• Pregnancy-related hormonal changes

• Diabetes mellitus

• Smoking

• Xerostomia (dry mouth)

• Irregular dental visits

Pathophysiology

Gingivitis develops through the interaction between bacterial plaque biofilm and host immune response:

1. Accumulation of plaque bacteria along the gingival margin.

2. Release of bacterial toxins and metabolic products.

3. Activation of host inflammatory response.

4. Vasodilation and increased vascular permeability.

5. Gingival edema, redness, and bleeding tendency.

At this stage, inflammation is confined to gingival tissues without attachment or bone loss, making the condition reversible.

Signs and Symptoms

• Gingival redness

• Swollen and shiny gingival tissue

• Bleeding during tooth brushing or gentle probing

• Spontaneous gingival bleeding

• Gingival tenderness

• Bad breath (halitosis)

• Mild discomfort during chewing

• Gingival enlargement in some patients

Diagnostic Criteria

Diagnosis is clinical and based on:

• Red and inflamed gingiva

• Edematous or shiny gingival surface

• Bleeding on probing or brushing

• Presence of dental plaque or calculus

• Absence of periodontal attachment loss

Investigations

Routine laboratory investigations are usually not required.

Dental assessment may include:

• Clinical periodontal examination

• Plaque index assessment

• Gingival bleeding index

• Dental radiographs when progression to periodontitis is suspected

• Blood glucose testing in recurrent or severe disease

Management

Treatment Principles

Management aims to:

• Eliminate dental plaque

• Control inflammation

• Restore gingival health

• Prevent progression to periodontitis

Non-Pharmacological Management

• Professional removal of plaque and calculus (scaling and polishing)

• Instruction on proper tooth brushing technique

• Regular dental flossing

• Tongue cleaning of dorsal surface

• Use of saline mouth rinse

• Correction of faulty dental restorations

• Smoking cessation counseling

• Regular dental follow-up

Pharmacological Management

Routine antibiotic therapy is not indicated in uncomplicated gingivitis.

Adjunctive therapy when required:

• Chlorhexidine gluconate 0.2% mouthwash used twice daily for 7–14 days

Important Note

• Mouthwash should not be swallowed.

• Long-term use should be avoided due to tooth staining.

(In accordance with Tanzania Standard Treatment Guidelines)

Complications

• Progression to periodontitis

• Periodontal pocket formation

• Gingival recession

• Tooth mobility in advanced disease

• Chronic halitosis

• Tooth loss if untreated

Prevention

• Brush teeth at least twice daily using fluoridated toothpaste

• Daily dental floss use

• Regular professional dental cleaning

• Balanced diet with reduced sugar intake

• Routine dental check-ups every 6 months

• Control systemic diseases such as diabetes

• Avoid tobacco products

Patient Education

• Gingivitis is reversible with proper oral hygiene

• Bleeding gums are abnormal and require attention

• Proper brushing technique is essential

• Regular dental visits prevent complications

• Early treatment prevents tooth loss

Prognosis

With adequate plaque control and professional dental care, gingivitis resolves completely without permanent tissue damage.