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Infectious Disease and Microbiology: Gingivitis
Gingivitis is an inflammation of the gingiva that commonly presents with localized bleeding, especially during brushing, and may progress to more serious periodontal disease if untreated. It can be classified into dental plaque–induced and non–plaque-induced types, with plaque-induced gingivitis being the most frequent form. In severe cases, it may lead to systemic symptoms such as fever or even tooth loss secondary to progression into periodontitis.
Epidemiologically, gingivitis is highly prevalent, particularly among adults over 35 years of age. Its incidence is increased in individuals with immunodeficiency and during pregnancy. Several risk factors contribute to its development, including poor dental hygiene, systemic diseases such as diabetes mellitus and coronary artery disease, malocclusion, malnutrition, and infections like HIV. Certain medications, including oral contraceptive pills and Phenytoin, are also associated with an increased risk.
The pathophysiology involves both acute and chronic inflammation of the gingiva due to accumulation of bacterial plaque at the gingival margin. This leads to hyperemia, infiltration of neutrophils, and bacterial proliferation. The most common causative organisms include Streptococcus species, actinomycetes, spirochetes, and various anaerobic bacteria. Persistent inflammation can eventually damage the supporting structures of the teeth.
Clinically, gingivitis often begins with bleeding gums during brushing, which is usually the earliest symptom. Patients may also report halitosis. On physical examination, the gingiva appears erythematous, edematous, and may bleed easily, with visible plaque and calculus. In advanced cases, the tissue may become necrotic, and a severe form known as Vincent’s angina may develop, characterized by pain, swelling, fever, and lymphadenopathy.
Diagnosis of gingivitis is primarily clinical, based on history and physical findings. Laboratory investigations are generally not required. It is important to differentiate gingivitis from other oral conditions such as periodontitis, glossitis, and pericoronitis. Close follow-up with a dental provider is essential to monitor progression and ensure adequate management.
Treatment focuses on removal of dental plaque and improvement of oral hygiene. Professional debridement and use of antimicrobial mouth rinses such as chlorhexidine are first-line measures. In severe cases, antibiotics targeting oral flora, including Metronidazole, penicillins, or clindamycin, may be required. Additional measures include elimination of local irritants, smoking cessation, and regular dental checkups.
The prognosis of gingivitis is excellent with appropriate treatment and adherence to good oral hygiene practices. However, recurrence is common if preventive measures are not maintained. Potential complications include progression to severe periodontal disease, tooth loss, gingival or bone abscess formation, and possible associations with systemic conditions such as coronary artery disease.
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