​Kembara Xtra - Medicine - Gingivitis

​Kembara Xtra - Medicine - Gingivitis 
An reversible form of gingival inflammation is gingivitis.
A gentle form of periodontal disease, that. Among the classifications are these: 
caused by plaque

Not caused by plaque (bacterial, viral, or fungal; examples include necrotizing ulcerative gingivitis, Vincent disease, or "trench mouth"); also not related to dentures
Modified by drugs (calcium channel blockers, antipsychotics, antiepileptics, antirejection medications, hormones), systemic variables (such as pregnancy, puberty, HIV, diabetes, smoking, leukemia), and malnutrition (vitamin deficiencies).
Acute or ongoing

Affected systems include the gastrointestinal, ear, nose, and throat, and dental 
Similar terms include gum disease and mild periodontal disease.

Aspects of Geriatrics

a lot more common in this age group

Child Safety Considerations

Children frequently experience cases of plaque-induced gingivitis (the most prevalent type of pediatric periodontal disease), which typically only calls for better oral hygiene.

pregnant women frequently experience this; it has a self-limited hormonal effect.

42% of adults in the US have periodontal diseases, with children, teenagers, and young adults being most at risk.

Pathophysiology and Etiology 
gingiva on the margins is inflamed.
When contacting supporting bone, this can develop into a more serious, damaging inflammation that is referred to as periodontitis rather than gingivitis.
Inadequate plaque clearance, drug-induced side effects (such those from oral contraceptives or antiepileptic drugs), and nutritional inadequacies
Vasoconstriction (methamphetamine, nicotine) and endocrine/hormonal changes such as menstruation, menarche, and pregnancy
Chronic illness with severe disability
Fusiform bacillus (Fusobacterium spp.) and spirochete (Borrelia vincentii) synergistically infect patients with Vincent disease, necrotizing ulcerative gingivitis, and other conditions.

Pathology: Papillary projections in subepithelial tissue, Acute or Chronic Inflammation, Hyperemic Capillaries, Polymorphonuclear Infiltration, Fibroblasts
Genetics
A rare disorder called hereditary gingival fibromatosis, where severe gingival hyperplasia covers teeth and is linked to hirsutism, may have a genetic component (affecting up to 30% of the population).

Risk factors include: HIV positive; AIDS; poor oral hygiene/plaque formation; pregnancy; uncontrolled diabetes mellitus; malocclusion, dental crowding, and defective dental restorations; smoking; mouth breathing; xerostomia; inadequate levels of vitamins C and Q10; use of dental appliances (dentures, braces); and necrotizing ulcerative gingivitis.
- Bronchial asthma and other respiratory conditions - Lack of sleep - Malnutrition - Viral sickness - Usually affecting teens and young adults - Rheumatoid arthritis - Epilepsy


Prevention 

Good oral care for adults
 Frequent, twice-daily use of fluoride-containing toothpaste
Powered toothbrushes, particularly those that oscillate and rotate, reduce gingivitis.
 Using water jets, interdental brushes, and daily "high-quality" flossing (studies have shown that flossing only benefits when done properly).Chlorhexidine is superior to other oral rinse substances for maintaining oral cleanliness.
Acute phase use. - Pediatrics
Regular twice-daily brushing with fluoride toothpaste while being watched by parents until the child has full hand dexterity (around age 8). Regular flossing is advised if there are no spaces between the teeth. A dentist or hygienist should clean your teeth every six months or as needed more regularly.
Brushing and mouthwash containing essential oils (menthol, thymol, and eucalyptol, such as Listerine)


Glossitis, periodontitis, and pedunculated growths (pyogenic granulomata) are associated conditions.


Gum erythema, edema, and bleeding are the symptoms of the diagnosis.
Gingiva is soft to the touch but painless otherwise.
Inquire about HIV risk, pregnancy, dietary deficits, diabetes, and other risk factors as appropriate. Bleeding of the gingiva after brushing, flossing, or eating.
A history of smoking A history of poor oral hygiene and few dental visits


clinical assessment 

Gums that are healthy should be pink, firm, stippled, and scalloped.
Gingivitis: Blunted papilla and edematous marginal gingiva (generally painless to the touch)
Gingiva erythema: a look of brilliant crimson or red-purple.
Blood when manipulating the gingiva, a biofilm of soft plaque and hard calculus, edema of the interdental papillae, and HIV gingivitis, also known as linear gingival erythema
Vincent disease/necrotizing ulcerative gingivitis - Ulcers - Fever - Malaise - Regional lymphadenopathy - Pain - Mouth odor - Narrow band of bright red inflamed gum surrounding neck of tooth - Painful - Bleeds easily - Rapid destruction of gingival tissue and can progress to periodontitis with destruction of underlying support tissues (periodontal ligament, supporting alveolar bone)


Multiple Diagnoses 
Glossitis, desquamative gingivitis, and periodontitis (deeper inflammation that damages alveolar bone, ligaments, and connective tissue) are among the conditions that can affect the gums.
Pericoronitis, a frequent adolescent condition where the gum flap covers a partially erupted third molar and traps food and debris,
Specific types of gingivitis, such as acute necrotizing ulcerative gingivitis (Vincent disease) and HIV gingivitis (linear gingival erythema), adrenal crisis, and leukemia. Gingival ulcers (aphthous, herpetic, malignancy, TB, syphilis).

Laboratory Results 

Initial examinations (lab, imaging)
No tests are often required
A possible smear or culture to determine the underlying cause (Candida, gram-negative anaerobes, and enteric strains are among the yeasts that can cause HIV gingivitis). 
Laboratory testing for underlying diseases (HIV, pregnancy, diabetes, nutritional deficits); C-reactive protein elevation


Management 

 Stop taking any drugs that may be a factor.
Eliminate irritating elements (plaque, calculus, subpar dental restorations, etc.).
Proper oral care 
Routine dental exams (to remove plaque and/or tartar and polish the teeth if they are dirty).
Quitting smoking
Use of tray-applied 10% carbamide peroxide gels for individuals with special needs

First Line of Medicine

You could use varnishes or rinses with chlorhexidine. (Note: Prolonged usage of chlorhexidine may cause metallic or altered tastes and a blackening of the tongue.)
Chlorhexidine and essential oil mouthwash (EOMW) may both be equally efficient in reducing gingival irritation.

 Only acute necrotizing ulcerative gingivitis (Vincent disease) is indicated for the use of antibiotics: - Penicillin V: 250 to 500 mg q6h for adults; 25 to 50 mg/kg/day divided for children.
Pediatric dose: 30 mg/kg/day PO/IV split every six hours; maximum daily dose: 4 g; adult dose: 500 mg bid or trid for 10 days. OR
- Amoxicillin/clavulanic acid: pediatric dose is 30 mg/kg/day PO given in divided doses every 12 hours; information: use 125 mg/31.25 mg/5 mL suspension; adult dose is 875 mg/125 mg PO given every two hours for ten days. Clindamycin: penicillin allergy; pediatric dose, 8 to 20 mg/kg/day in 3 to 4 divided doses as hydrochloride; adults, 300 mg q6h (maximum 1.8 g/day). Erythromycin: pediatric dose, 30 to 40 mg/kg/day divided q6h; adult dose, 250 mg q6h. - Doxycycline: 100 mg BID on the first day and then 10 mg QD for adults.
Topical corticosteroids, such as Triamcinolone 0.1% in Orabase (spray or ointment), should be used locally TID and QID.

Second-line treatments include acetaminophen or ibuprofen for pain, other antibiotics or antifungal rinses or systemic treatments based on culture or smear results, and decapinol oral rinse (a surfactant that acts as a physical barrier, making it harder for bacteria to stick to the polysaccharide pellicle on tooth and mucosal surfaces). Decapinol oral rinse is not advised for use by pregnant women or children under the


Concerns to refer 

If acute gingivitis progresses to periodontitis, extensive root scaling, root planing, and antibiotics may be necessary. Routine cleanings and additional treatment, if needed.

Débridement for acute necrotizing gingivitis Minor surgery may be required to treat tissue overgrowth in cases of inherited gingival fibromatosis or medication-induced gingivitis.

Coenzyme Q10 can be applied topically to restore coenzyme Q10 deficit, and bilberry may be useful in lowering inflammation and maintaining collagen tissue. You can also replace any nutritional deficiencies (such a lack of vitamins A, B12, or C).

Patient Follow-Up Monitoring
Dental follow-up for ongoing cleanings and secondary prevention till all is clear

Eat a well-balanced diet rich in fruits, vegetables, and vitamin C; stay away from sugary snacks and drinks, which promote the formation of plaque.

Soft meals during a flare-up, especially if there is severe bleeding or swelling. Good oral hygiene, including twice-daily use of an electric toothbrush with a circular motion and fluoridated toothpaste. 

Usual course: acute, relapsing, intermittent; chronic; prognosis: generally positive, responds well to appropriate treatment; untreated, may proceed to periodontitis (controversial), which is a significant factor in tooth loss.

Complication: Severe periodontal disease (which is linked to tooth loss, heart disease, diabetes, dementia, and preterm birth as well as supporting bone loss)

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