Gingivitis – Symptoms and Treatment

Definition of the Disease. Causes of the Disease

Gingivitis is an inflammatory condition of the gums characterized by pain, swelling, bleeding, and exudate secretion (fluid produced by tissues in response to inflammation).

Inflamed gums become soft, rough, and loosely attached to the tooth crowns. According to the World Health Organization, inflammatory processes of the soft tissues of the oral cavity are present in more than 90-95% of adults, and tooth loss due to gum and periodontal inflammation occurs 5 times more often than due to caries [1]. In most cases, gingivitis occurs due to the accumulation of dental plaque resulting from poor oral hygiene. Plaques from plaque constantly irritate the mucous membrane, form pockets (increasing the distance between the tooth and soft tissues), in which bacteria actively multiply. Thus, bacteria are most often the cause of gum inflammation. In addition, gingivitis may be a consequence of allergies, fungal, and viral infections.

Provoking factors in the development of gum inflammation include:

  • Hormonal changes;
  • Diabetes mellitus;
  • Hypovitaminosis;
  • Acquired (HIV) and congenital immunodeficiencies (Di George syndrome);
  • Pregnancy;
  • Leukemia;
  • Vitamin C deficiency;
  • Family history (having close relatives who have suffered from inflammatory gum diseases);
  • Gum injury.

Mucosal damage can occur with incorrect bite, dental manipulations, exposure to aggressive chemicals, use of a hard toothbrush, and consumption of hard food. Even minor epithelial trauma is a gateway for infection. Among the iatrogenic (related to medical manipulations) factors contributing to inflammation are sharp edges of dental prostheses, crowns, unpolished fillings, and those adjacent to the gum.

Symptoms of Gingivitis

In the initial stage of the disease, patients complain of discomfort in the oral cavity. Upon examination, the affected area of the gums is hyperemic (i.e., reddened) and swollen. Bleeding may occur during eating solid food and brushing teeth. Pain is usually not present in the early stages of the disease. Many patients complain of increased salivation.

Reddening of the gums and healthy gums

Inflamed gums recede from the tooth surface, leaving behind food debris in the formed pocket, resulting in an unpleasant odor from the mouth. If left untreated, bacteria actively multiply in the pocket, leading to tooth decay at the tooth neck.
Over time, gum pain develops, which worsens during meals and dental examinations. The pain is particularly pronounced when consuming hot, cold, or acidic foods. With severe inflammation or widespread processes, not only local but also general symptoms may appear: fever, weakness, increased fatigue, irritability.
During examination, a dentist observes changes in the color of the affected mucous membrane, hypertrophy (increase in volume) of interdental papillae, and gum margins. Typically, dental plaque, tartar, and carious lesions are present in the area of inflammation. Bleeding may occur when examining the gums with dental instruments. In chronic inflammation, the clinical picture may be blurred, but pronounced hypertrophy of soft tissues may be observed. With a prolonged process, overgrown gums can cover almost the entire tooth crown. In desquamative (with the appearance of blisters on the gums) and ulcerative forms of gingivitis, blisters and ulcers may form on the gums.

Classification and Stages of Gingivitis

According to the International Classification of Diseases 10th Revision (ICD-10), acute and chronic courses of gingivitis are distinguished:

  1. Acute gingivitis is characterized by pain and discomfort, often accompanied by bleeding, and the soft tissues are hyperemic.
  2. Chronic inflammation sometimes causes discomfort, with patients being bothered by bad breath, and the gum margin is often thickened like a roll. Chronic gingivitis is classified into the following types:
  • Chronic unspecified;
  • Desquamative (with the appearance of blisters on the gums);
  • Hyperplastic (manifested by gum overgrowth);
  • Simple marginal (affecting the gum margin);
  • Ulcerative.
    Based on the extent of the inflammatory process, gingivitis can be localized or generalized. In the latter case, general symptoms such as fever and weakness are often observed.
    Based on the severity of the condition:
  • Mild mucosal lesions affect only the interdental papillae.
  • Moderate lesions involve the free gum margin in the inflammatory process.
  • Severe mucosal lesions involve the soft tissues attached to the tooth.
    Based on morphological features:
  • Catarrhal gingivitis: characterized by the secretion of a large amount of exudate, pronounced redness of the mucous membrane, swelling, pain, and local temperature elevation.
  • Hypertrophic gingivitis: the papillae between the teeth enlarge, eventually they may completely cover the tooth crowns. The gums acquire a bluish tint, bleed during eating, toothbrushing, or dental examination, and deep gum pockets form.
  • Ulcerative gingivitis: the mucous membrane takes on a grayish hue, areas of destruction are visible.

In the early stages of the disease, redness, swelling, and bleeding of the gums are noted. If timely dental care is sought, inflammation can be quickly alleviated, and the soft tissues can be fully restored. If left untreated, destructive processes develop in the gums, with defects replaced by granulation tissue. If inflammation continues to progress, the process may extend to the periodontal tissues, leading to tooth loss.

Complications of Gingivitis

Gingivitis is not as harmless as some patients may think. Many believe that the inflammation will pass on its own without leaving a trace. This is possible only with a small focus of infection and a strong immune system. It should be remembered that inflamed gums are a source of infection that can spread in the oral cavity and lead to serious consequences. That’s why it’s important to seek medical help at the first signs of gingivitis. The most common complications of gingivitis include:

  • Ulcerative-necrotic changes in the mucous membrane;
  • Periodontitis (inflammation of the periodontium);
  • Periapical periodontitis (inflammation of the connective tissue that fixes the tooth in the jaw bone);
  • Spread of infection beyond the oral cavity.

In gingivitis, the immune forces of the body (lymphocytes and macrophages) and toxins released by bacteria act on the oral mucosa. If the inflammatory process is not controlled in time, the epithelium will begin to deteriorate. In the initial stages, this process is reversible, but with prolonged disease progression, the gums hypertrophy due to granulation tissue. In this case, therapeutic treatment may be ineffective.

Diagnosis of Gingivitis

The diagnosis begins with the doctor listening to the patient’s complaints and gathering medical history. Typically, the clinical picture is quite typical. It is necessary to find out how long the first symptoms appeared and whether any treatment has been administered. When collecting medical history, attention should be paid to the presence of chronic diseases, hormonal disorders, and the assessment of the immune status. These factors are important in determining the treatment strategy.
During the examination, a dentist can easily identify the altered area of the gums. The doctor’s task is to determine the severity of the lesion, assess the extent of the process, and determine whether the tissues of the periodontium and the periosteum are involved in the inflammation. It is also necessary to determine the cause of gingivitis and eliminate it. If the gums are constantly damaged by the sharp edge of the crown, alleviating inflammation is a temporary measure. Without eliminating the damaging factor, the disease will recur.
If there is suspicion of the spread of the process beyond the gums, additional examinations are necessary to assess the condition of the tooth root, jawbone, and periodontium. X-rays are widely used for this purpose.
If the process is generalized (spread throughout the body), the patient needs to undergo a complete blood count. It allows assessing the body’s response to inflammation and determining the severity of the condition.
Additional methods used for diagnosis include:

  • Schiller-Pisarev test – determining glycogen levels, which sharply increase during inflammation;
  • Determination of bleeding index;
  • Kulazhenko test – determining the resistance and permeability of the microcirculatory bed;
  • Polarography – determining the level of oxygen in the periodontal tissues;
  • Reoparodontography – studying the functional state of the blood vessels of the periodontal tissues by registering the pulsating blood flow in them.

Gingivitis is often detected during routine check-ups. In this case, patients may not present any complaints, as the process can be asymptomatic in the early stages. That’s why it’s important to visit the dentist every 6 months.

Treatment of Gingivitis

Successful treatment primarily involves eliminating the cause of inflammation. For this purpose, plaque and tartar removal are mandatory.

In the initial stages of the disease, these procedures and the use of local antiseptics are usually sufficient. Metronidazole, chlorhexidine, infusions of sage and chamomile are used to alleviate inflammation. Local application of “Solcoseryl” and sea buckthorn oil is recommended to improve regeneration.

If a crown, filling, or tooth chip leads to constant gum damage, dental treatment is necessary to eliminate the damaging factor. The gum should be in contact with a smooth surface without roughness or sharp edges.

If the inflammation is widespread, the patient’s general condition is affected, and blood tests show signs of inflammation, a course of antibiotics effective against gram-negative flora is prescribed. Immunostimulants and vitamins are also used.

If the patient experiences significant pain, analgesics from the group of NSAIDs (nonsteroidal anti-inflammatory drugs) are added to the therapy.

In comprehensive gingivitis therapy, physiotherapeutic treatment methods are sometimes used as additional treatment:

  • Electrophoresis with aloe, ascorbic acid;
  • Phonophoresis with heparin ointment;
  • Quartz lamp irradiation;
  • Laser therapy;
  • Darsonvalization;
  • Vacuum massage of the gums.

In the case of hypertrophic gingivitis, the listed treatment measures may not yield positive results. In such cases, injections of sclerosing agents are administered to compact the overgrown soft tissues into the interdental papillae. If attempts to eliminate overgrown granulation tissue using this method fail, cryodestruction (freezing and removal of tissues using liquid nitrogen), diathermocoagulation (excision of mucosal tissues using a hot instrument), or surgical removal using a scalpel – gingivectomy may be necessary.