Gingivitis

Causes of gingivitis

The most common type of gingivitis is caused by bacterial plaque which gets accumulated and attached to the tooth surface and cause inflammation. Whenever there is an irritant present at the site, there is an increased blood flow to that area to take the toxins away and as the vascularity is increased the blood vessels become fragile and bleed at any instance of mechanical or any other stimuli.

Signs and symptoms of gingivitis

The earliest symptom noticed is bleeding from the gums on probing or touching. Bleeding from the gums can also occur due to any trauma to the gums that is, by tooth brush, tooth picks or food impaction, by grinding of teeth, or by biting into hard foods for example, apples etc. There are also some systemic disorders which show signs of bleeding from gingiva. Bleeding occurs spontaneously or excessively following irritation to the area. The haemorrhagic disorders in which abnormal bleeding from the gingiva is noticed are Vitamin C deficiency, platelet disorders, Vitamin K deficiency, haemophilia, etc. Certain drugs in excessive amounts too can contribute to this condition for example, anticoagulants, salicylates (asprin) etc. Another sign is the change in colour of the gingiva from coral pink which is noticed in normal healthy gingival to a redder colour due to increased blood flow to bluish red colour.

Other factors which causes change in colour in an otherwise normal gingiva are due to certain metallic pigmentation due to bismuth, arsenic, mercury, lead and silver.

Certain systemic diseases also cause changes in colour for example, jaundice etc

Treatment for gingivitis

The treatment involves primarily identifying the cause of the gingival inflammation and treating the cause. If the disease is caused due to bacterial plaque built up, a good session of thorough cleaning is an ideal treatment followed by strict oral hygiene measures. Follow-ups are necessary for cessation of this disease.

ACUTE NECROTIZING ULCERATIVE GINGIVITIS

It is a destructive and inflammatory disease of the gingiva.

Signs and symptoms

It is characterised by a sudden occurence. Sometimes it occurs following an acute respiratory tract infection or a debilitating disease. It features in patients who have psychological stress, a change in living habits and long working hours without rest can also be seen in the history.

Signs

1. Increased salivation
2. Foetid odour and foul taste
3. Bleeding from gingiva at the slightest touch
4. The gingiva between the teeth shows crater like depression and are covered by a grey membrane
5. Lesions are very painful to touch
6. Gnawing and radiating pain is often felt
7. There is a slight increase in temperature and lymph node enlargement is also noticed in mild stages of the disease

In severe cases high fever, increased pulse rate, loss of appetite, general weakness, loss of sleep, constipation, stomach disorders, depression and headache are also noticed.

Treatment

The patient’s complete medical history including past and present diseases are taken into account. Daily routine work and life style details are noted. The treatment is divided into two for two different conditions. 

Patients who show high temperature, weakness etc.

In this condition the following steps are to be taken care of:

• The grey coloured membrane is to be removed with cotton pellets soaked in hydrogen peroxide.
• Rinsing of the mouth with a glass full of water and 3% hydrogen peroxide in equal amounts should be done every 2 hours.
• Antibiotics are to be given for seven days and then the patient has to report back to the dentist after 24 hours to see the progress.
• The patient is advised complete bed rest.

Patients who have slightly elevated temperature with localized lymph node enlargement, but show no serious complications. In this condition the area which are acutely involved are treated:

• An anesthetic solution is applied on the affected area and after a few minutes the grey coloured membrane is removed with some cotton.
• After this the dentist uses ultrasonic scalers to remove the calculus deposited on the tooth surface.

Here the patient has to be aware of the fact that even when the pain subsides the treatment is not complete.

Therefore, regular follow ups are necessary to identify any causative factors. The instructions to be followed are:

• Stop use of alcohol, tobacco etc.
• An equal mixture of hydrogen peroxide 3% and water to be used to rinse mouth every 2 hours.
• Carefully and gently use tooth brush to clean and use dental floss and chlorhexidine as mouth wash.
• Avoid physical exertion or prolonged exposure to the sun.

Reference

1. Dr. Sachin Arora, Defeat Dental Problems, 2010, 132p