Gingivitis

Definition

Gingivitis is a disorder involving inflammation of the gingiva (gum tissue). It is sometimes called gum disease.

Description

Periodontal disease is a worldwide problem. This mildest form of periodontal disease, gingivitis, is inflammation strictly limited to the gingiva and does not manifest changes in the underlying bone. When bony changes become evident, the condition is termed periodontitis .

There is commonly little or no discomfort with gingivitis. The only people who escape gingivitis are very young infants; otherwise, it affects all age groups and people of all ethnic and racial backgrounds. A bacterial infection of the gums, it causes the gum tissues to turn red and swollen. Mild gingivitis causes little pain , and may be overlooked by the dentist; however, if left unchecked, it can turn into severe gingivitis. Many people experience varying degrees of gingivitis throughout their lives, but overlook it. It commonly develops during puberty or in early adulthood, and may persist or recur frequently.

In studies cited by the American Academy of Periodontology (AAP) in Boston, Massachusetts, 1,259 patients between the ages of 13 and 65 were studied. Of those 1,259 between ages 13 and 15, 80% had some form of gingivitis, while 95% had gingivitis at age 60. Males were more frequently affected than females, with the overall average being 88% and 80%, respectively.

Causes and symptoms

The etiology of gingivitis is especially varied and has been divided into local and systemic factors.

Local factors

• microorganisms
• food impaction
• faulty or irritating restorative orthodontic appliances
• breathing through the mouth, rather than the nose
• tooth malposition
• chemical or drug application

Microorganisms are the bacteria found in plaque. The bacteria that destroy living tissue release many destructive enzymes. Specific microorganisms sometimes cause inflammatory reactions in the gingiva. Streptococcal and Staphylococcal are the bacteria known to destroy tissue and cause inflammation.

Food impaction, or general oral neglect, is the most common cause of gingivitis. The food impacts around the teeth and accumulation of debris on the teeth causes irritation of the gingiva by the toxins in the plaque. The byproducts of the toxins cause swelling of the tissue and redness to occur.

Faulty or irritating restoration, or appliances, may act as irritants to the gum tissue and thus induce gingivitis. Overhanging margins on dental fillings may directly irritate the gingiva and cause food to become impacted; this further adds to making the gum tissue even more tender. When prosthetic or orthodontic appliances encroach on the gingival tissues, gingivitis may occur—the result of the pressure and the trapping of food and bacteria. The tissue may become inflamed, redden, and become painful to the touch.

Mouth breathing (not breathing through the nose) causes drying of the oral mucous membrane and irritates the gum tissue, causing inflammation and hyperplasia of the tissue.

Tooth malposition results in repeated abnormal forces during the eating and chewing of food. Calculus may be deposited on the surface of the tooth that has no force to aid in keeping it clean. Bacteria may begin to attack the tissue around the tooth, resulting in a combination of inflammation and gum recession.

KEY TERMS

Calculus —A hard deposit that forms on the teeth, also known as hardened plaque and tartar.

Edematous —An abnormal accumulation of serous fluid in the tissues.

Gingiva —The gum tissue.

Gum recession —The gum tissue backing away from the crown of tooth towards the root.

Hyperemia —Swelling of the gum tissue.

Local —Pertaining to or being in one particular place.

Systemic —Pertaining to, or affecting the whole body.

Chemical or drug application may cause many gum tissue anomalies. A number of drugs are at least potentially capable of inducing gingivitis. Over-the-counter (OTC) drugs can be harmful to the gum tissue and act as an acid burn if used. Silver nitrate and general aspirin have acidic affects on the gum tissue, causing redness and tenderness to the touch. Dilantin sodium produces swelling of the gum tissue due to the chemicals in the drug.

Systemic factors

• nutritional disturbances
• pregnancy
• diabetes and other conditions that cause endocrine dysfunction

Nutritional disturbances can create imbalances in the body system that effect changes in the gum tissue. Insufficient vitamin C may cause redness and swelling, along with tenderness. The inadequate intake, absorption, and utilization of some other vitamins , minerals , and food can affect the gum tissue, causing swelling and redness.

Pregnancy gingivitis refers to the changes the gingiva undergoes during pregnancy. The clinical appearance of the gingiva in pregnant women may vary—from no change to a smooth, shiny, deeply reddened, marginal gingival hyperemia (swelling of the gum tissue) of the papilla on the upper roof of the mouth. Gingivitis commonly appears at the end of the first trimester of pregnancy, and may remit or even completely disappear at the termination of the pregnancy.

Diabetes mellitus is also associated with severe periodontal disease. Uncontrolled diabetes can cause a metabolic change in the gum tissue and decrease an individual's resistance to infection.

Endocrine dysfunctions during puberty may lead to changes in the gum tissue (puberty gingivitis). The gingiva appears hyperemic (having an excess of blood ) and edematous (swollen). Most studies have revealed that the main cause of these changes in the gingiva is caused by breathing through the mouth.

Diagnosis

A patient may have gingivitis and periodontitis in different parts of the mouth at the same time. A general dentist can examine the patient and look for calculus deposits on the teeth and under the gum line. A dental explorer or a cleaning instrument will then be used by the dentist to probe the gum tissue or to check for plaque buildup. Commonly, the practitioner will ask the patient if the gums bleed while flossing and brushing. The dentist needs to be made aware of any medications being taken that might be a causative factor in the gingivitis. Information provided by the patient may lead to a gingivitis diagnosis.

Treatment

The goal of treating gingivitis is for reduction of the gingival inflammation. The general dentist, or registered dental hygienist (RDH) commonly cleans the teeth. This may involve the use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Gingivitis is reversible with professional treatment and good home oral hygiene care. Changing toothbrushes every three months commonly improves dental hygiene in eliminating the bacteria in the mouth. Increased intake of vitamin C may aid in the development of healthy gum tissue. It is strongly recommended that strict oral hygiene be maintained for one's lifetime, or gingivitis will probably recur.

Prognosis

The prognosis for gingivitis is excellent. Once a program of good dental hygiene, such as proper toothbrushing and frequent prophylaxis (cleaning) is implemented, the symptoms of gingivitis will begin to disappear; this can happen in as little as one week. If there is poor response to good local therapy, a search should be made for systemic factors, which might be complicating the case.

Regular dental cleanings and exams are recommended at least every six to twelve months.

Health care team roles

An RDH is usually the first person seen by the patient when a cleaning is scheduled. The RDH role is to inform the patient of the condition of the gum tissues and consult with the general dentist about the treatment plan. After evaluating the case, ways to improve oral hygiene or to identify the irritant causing the gingivitis—such as a popcorn kernel, seed, or tartar buildup—will be suggested. Removal will then by done by the dentist.

Proper brushing and flossing is usually demonstrated by the RDH. This will aid in the maintenance of oral hygiene. The front desk receptionist may be responsible for keeping track of the recall records and following up with patients, by phone, who need appointment every six months.

Prevention

Prevention of gingivitis is simple and easy. Proper brushing techniques and proper flossing to remove any irritants or bacteria helps to stop gingivitis from growing. Regular dental checkups and cleanings will aid in reducing the risk of gingivitis.

For people who are prone to gingivitis, it may be recommended that they brush and floss after every meal, and at bedtime. Electric toothbrushes may be recommended for patients who have problems with strength or dexterity of their hands. Special appliances or tools, such as toothpicks, special toothbrushes, and water irrigation devices may be recommended for patients who are particularly prone to plaque deposits. These supplements do not replace brushing and flossing, but are enhancements in the prevention of gingivitis.

Resources

ORGANIZATIONS

Adam.com Health and Medical Association Online. adam.com. 90 Tehama Street, San Francisco, CA 94105(415) 541-9164. <http://www.adam.com/home.htm>.

American Academy of Periodontology, 4157 Mountain Road, PBN 249 Pasadena, MD 21122, (410) 437-3749. <http://www.perio.org>.

American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2500. <http://www.ada.org>.

Inteli Health Dental. Inteli Health Inc. 960C Harvest Drive P.O. Box 1097, Blue Bell, PA 19422(215) 775-5155. <http://www.intelihealth.com>.

OTHER

ADA News Release. Silent Dental Disease is Number One Concern Among Dentists. July 1999.

"Gingivitis." Adam.com Health Issues. <http://merckmedco.adam.com/ency/article/001056.htm.>.

"Gingivitis." Inteli Health Dental. University of Pennsylvania School of Dental Medicine. January 2001.

Cindy F. Ovard, R.D.A

Gingivitis

Definition

Gingivitis is a disorder involving inflammation of the gingiva (gum tissue). It is sometimes called gum disease.

Description

Periodontal disease is a worldwide problem. This mildest form of periodontal disease, gingivitis, is inflammation strictly limited to the gingiva and does not manifest changes in the underlying bone. When bony changes become evident, the condition is termed periodontitis.

There is commonly little or no discomfort with gingivitis. The only people who escape gingivitis are very young infants; otherwise, it affects all age groups and people of all ethnic and racial backgrounds. A bacterial infection of the gums, it causes the gum tissues to turn red and swollen. Mild gingivitis causes little pain, and may be overlooked by the dentist; however, if left unchecked, it can turn into severe gingivitis. Many people experience varying degrees of gingivitis throughout their lives, but overlook it. It commonly develops during puberty or in early adulthood, and may persist or recur frequently.

In studies cited by the American Academy of Periodontology (AAP) in Boston, Massachusetts, 1,259 patients between the ages of 13 and 65 were studied. Of those 1,259 between ages 13 and 15, 80% had some form of gingivitis, while 95% had gingivitis at age 60. Males were more frequently affected than females, with the overall average being 88% and 80%, respectively.

Causes and symptoms

The etiology of gingivitis is especially varied and has been divided into local and systemic factors.

Local factors

• microorganisms
• food impaction
• faulty or irritating restorative orthodontic appliances
• breathing through the mouth, rather than the nose
• tooth malposition
• chemical or drug application

Microorganisms are the bacteria found in plaque. The bacteria that destroy living tissue release many destructive enzymes. Specific microorganisms sometimes cause inflammatory reactions in the gingiva. Streptococcus and Staphylococcus are the bacteria known to destroy tissue and cause inflammation.

Food impaction, or general oral neglect, is the most common cause of gingivitis. The food impacts around the teeth and accumulation of debris on the teeth causes irritation of the gingiva by the toxins in the plaque. The byproducts of the toxins cause swelling of the tissue and redness to occur.

Faulty or irritating restoration, or appliances, may act as irritants to the gum tissue and thus induce gingivitis. Overhanging margins on dental fillings may directly irritate the gingiva and cause food to become impacted; this further adds to making the gum tissue even more tender. When prosthetic or orthodontic appliances encroach on the gingival tissues, gingivitis may occur—the result of the pressure and the trapping of food and bacteria. The tissue may become inflamed, redden, and become painful to the touch.

Mouth breathing (not breathing through the nose) causes drying of the oral mucous membrane and irritates the gum tissue, causing inflammation and hyperplasia of the tissue.

Tooth malposition results in repeated abnormal forces during the eating and chewing of food. Calculus may be deposited on the surface of the tooth that has no force to aid in keeping it clean. Bacteria may begin to attack the tissue around the tooth, resulting in a combination of inflammation and gum recession.

Chemical or drug application may cause many gum tissue anomalies. A number of drugs are at least potentially capable of inducing gingivitis. Over-the-counter (OTC) drugs can be harmful to the gum tissue and act as an acid burn if used. Silver nitrate and general aspirin have acidic affects on the gum tissue, causing redness and tenderness to the touch. Dilantin sodium produces swelling of the gum tissue due to the chemicals in the drug.

Systemic factors

• nutritional disturbances
• pregnancy
• diabetes and other conditions that cause endocrine dysfunction

Nutritional disturbances can create imbalances in the body system that effect changes in the gum tissue. Insufficient vitamin C may cause redness and swelling, along with tenderness. The inadequate intake, absorption, and utilization of some other vitamins, minerals, and food can affect the gum tissue, causing swelling and redness.

Pregnancy gingivitis refers to the changes the gingiva undergoes during pregnancy. The clinical appearance of the gingiva in pregnant women may vary—from no change to a smooth, shiny, deeply reddened, marginal gingival hyperemia (swelling of the gum tissue) of the papilla on the upper roof of the mouth. Gingivitis commonly appears at the end of the first trimester of pregnancy, and may remit or even completely disappear at the termination of the pregnancy.

Diabetes mellitus is also associated with severe periodontal disease. Uncontrolled diabetes can cause a metabolic change in the gum tissue and decrease an individual's resistance to infection.

Endocrine dysfunctions during puberty may lead to changes in the gum tissue (puberty gingivitis). The gingiva appears hyperemic (having an excess of blood ) and edematous (swollen). Most studies have revealed that the main cause of these changes in the gingiva is caused by breathing through the mouth.

Diagnosis

A patient may have gingivitis and periodontitis in different parts of the mouth at the same time. A general dentist can examine the patient and look for calculus deposits on the teeth and under the gum line. A dental explorer or a cleaning instrument will then be used by the dentist to probe the gum tissue or to check for plaque buildup. Commonly, the practitioner will ask the patient if the gums bleed while flossing and brushing. The dentist needs to be made aware of any medications being taken that might be a causative factor in the gingivitis. Information provided by the patient may lead to a gingivitis diagnosis.

Treatment

The goal of treating gingivitis is for reduction of the gingival inflammation. The general dentist or registered dental hygienist (RDH) commonly cleans the teeth. This may involve the use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Gingivitis is reversible with professional treatment and good home oral hygiene care. Changing toothbrushes every three months commonly improves dental hygiene in eliminating the bacteria in the mouth. Increased intake of vitamin C may aid in the development of healthy gum tissue. It is strongly recommended that strict oral hygiene be maintained for one's lifetime, or gingivitis will probably recur.

Prognosis

The prognosis for gingivitis is excellent. Once a program of good dental hygiene, such as proper toothbrushing and frequent prophylaxis (cleaning) is implemented, the symptoms of gingivitis will begin to disappear; this can happen in as little as one week. If there is poor response to good local therapy, a search should be made for systemic factors, which might be complicating the case.

Regular dental cleanings and exams are recommended at least every six to twelve months.

Health care team roles

An RDH is usually the first person seen by the patient when a cleaning is scheduled. The RDH role is to inform the patient of the condition of the gum tissues and consult with the general dentist about the treatment plan. After evaluating the case, ways to improve oral hygiene or to identify the irritant causing the gingivitis—such as a popcorn kernel, seed, or tartar buildup—will be suggested. Removal will then by done by the dentist.

Proper brushing and flossing is usually demonstrated by the RDH. This will aid in the maintenance of oral hygiene. The front desk receptionist may be responsible for keeping track of the recall records and following up with patients, by phone, who need appointment every six months.

Prevention

Prevention of gingivitis is simple and easy. Proper brushing techniques and proper flossing to remove any irritants or bacteria helps to stop gingivitis from growing. Regular dental checkups and cleanings will aid in reducing the risk of gingivitis.

For people who are prone to gingivitis, it may be recommended that they brush and floss after every meal, and at bedtime. Electric toothbrushes may be recommended for patients who have problems with strength or dexterity of their hands. Special appliances or tools, such as toothpicks, special toothbrushes, and water irrigation devices may be recommended for patients who are particularly prone to plaque deposits. These supplements do not replace brushing and flossing, but are enhancements in the prevention of gingivitis.

KEY TERMS

Calculus— A hard deposit that forms on the teeth, also known as hardened plaque and tartar.

Edematous— An abnormal accumulation of serous fluid in the tissues.

Gingiva— The gum tissue.

Gum recession— The gum tissue backing away from the crown of tooth towards the root.

Hyperemia— Swelling of the gum tissue.

Local— Pertaining to or being in one particular place.

Systemic— Pertaining to, or affecting the whole body.

Resources

ORGANIZATIONS

Adam.com Health and Medical Association Online. adam.com. 90 Tehama Street, San Francisco, CA 94105. (415) 541-9164. 〈http://www.adam.com/home.htm〉.

American Academy of Periodontology. 4157 Mountain Road, PBN 249 Pasadena, MD 21122. (410) 437-3749. 〈http://www.perio.org〉.

American Dental Association. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.

InteliHealth Dental. InteliHealth Inc. 960C Harvest Drive P.O. Box 1097, Blue Bell, PA 19422. (215) 775-5155. 〈http://www.intelihealth.com〉.

OTHER

ADA News Release. Silent Dental Disease is Number One Concern Among Dentists. July 1999.

"Gingivitis." Adam.com Health Issues. 〈http://merckmedco.adam.com/ency/article/001056.htm.〉.

"Gingivitis." InteliHealth Dental. University of Pennsylvania School of Dental Medicine. January 2001.

Gingivitis

Definition

Gingivitis is a mild form of gum disease that is treatable and reversible.

Description

Gingivitis is a very common disease in which the gums around the teeth become swollen, inflamed and bleed easily. Gingivitis is a type of periodontal disease caused by plaque build-up around the teeth and gums as a result of poor oral hygiene (including inadequate brushing and flossing). Plaque is a substance comprised of bacteria that hardens to form tartar. When plaque remains on the teeth for a period of time the gums become irritated leading to gingivitis. Periodontal disease affects the gums and bone structures that support the teeth. If left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease, which can cause tooth loss.

Demographics

Gingivitis begins in childhood and increases dramatically at puberty. It commonly occurs in adults. It is thought that gingivitis is more common in males since females practice better oral hygiene.

Causes and symptoms

There are other causes for gingivitis beside gingivitis caused by plaque. Risk factors for the development of gingivitis include tobacco use, medications, vitamin deficiency and poor nutrition , illness and infections, pregnancy, menopause , family history, mouth breathing, and other dental problems.

Tobacco increases bacterial growth in the mouth and adversely affects the immune system increasing vulnerability to infection. Treatments for gingivitis are less effective if using tobacco products.

Many medications (prescription and over-the-counter) reduce saliva production. Saliva helps to slow down the growth of bacteria so decreased saliva allows plaque to build up more easily. Some drugs cause overgrowth of gum tissue making plaque harder to remove leading to development of gingivitis.

A diet lacking in vitamins , including vitamins B and C, as well as calcium can contribute to the development of gingivitis. Deficiency of vitamin C and niacin (a type of B vitamin) can result in gum inflammation and bleeding gums. A diet lacking in vitamin B can contribute to the development of gum disease. Calcium helps to maintain health of the bones that support the teeth.

Cancer and Human immunodeficiency virus (HIV) interfere with the body's immune system which increases the risk of periodontal disease. Leukemia cells may invade gum tissue leading to gingivitis. Diabetes decreases the body's ability to fight bacteria attacking the gums. Viral and fungal infections may cause gingivitis. Hormonal changes associated with pregnancy and menopause increase vulnerability to bacterial gum infection.

Afamily history of dental disease increases the risk of gingivitis. Mouth breathing dries the mucous membranes of the mouth leading to inflammation and overgrowth of gum tissue. Other dental problems such as grinding the teeth, poorly fitting dentures, improper bite, or poorly fitting mouth appliances, e.g. braces, bridges, and crowns, can irritate the gums which increase the risk of gingivitis. Misaligned or crowded teeth make it more difficult to maintain good oral hygiene leading to gingivitis. Symptoms of gingivitis include swollen, tender gums, inflammation and redness on the gums around the teeth, gums that bleed easily, e.g. when eating or brushing the teeth, receding gum tissue or changes in shape of gum, and bad breath.

Diagnosis

Diagnosis is made by a physician or dentist based on the results of a medical and dental history and an oral examination. Examination should include evaluation for underlying disease.

A dentist should be consulted if symptoms of gingivitis are present. Dental x-rays may be ordered and a measurement of the dental bone (dental gingival probing) may be done to assess whether or not the supporting structures of the teeth have become inflamed.

Treatment

Goals of treatment are to remove the plaque and decrease inflammation. All plaque and tartar should be removed by a dentist or dental hygienist through a procedure called scaling. Because the gums are already sensitive and inflamed due to gingivitis, scaling may be uncomfortable. Once the plaque is removed, careful mouth care that includes regular brushing and flossing are needed to reduce further plaque formation. An antibacterial mouthwash may also be recommended. Routine visits (at least twice a year or more often for severe cases of gingivitis) to a dentist or dental hygienist are important to remove plaque that brushing and flossing do not remove. Severe cases of gingivitis may require antibiotics to fight bacterial infection. Other dental problems, e.g. misaligned or crowded teeth, poorly fitting mouth appliances, and improperly fitting dentures, should be treated. Over-the-counter analgesics and anti-inflammatory medication may reduce discomfort.

Nutrition/Dietetic concerns

Maintain a diet adequate in vitamins and nutrients, especially calcium. Eat foods high in antioxidants (substances that help to repair damage to the body) including foods that contain vitamins A, E, and C. Foods that contain vitamin A include carrots, squash, broccoli, sweet potatoes, tomatoes, kale, collards, cantaloupe, peaches and apricots (bright-colored fruits and vegetables). Foods high in vitamin E include nuts and seeds, whole grains, green leafy vegetables, vegetable oil and liver oil. Citrus fruits like oranges and lime, green peppers, broccoli, green leafy vegetables, strawberries and tomatoes are foods high in vitamin C. Calcium helps to promote bone health including dental bones. Foods rich in calcium include dairy products, soy, canned salmon, dark green vegetables, dried beans, and calcium-fortified foods like orange juice.

Therapy

To prevent the occurance of gingivitis, individuals should stop smoking , avoid alcohol, and maintain a well-balanced diet. Visit your dentist at least every six months. Brushing after every meal or snack is preferable but brush at least twice a day and floss at least once a day. Use toothpaste with fluoride, use a toothbrush with soft bristles. Replace your toothbrush every few months or more often if the bristles become worn. The size and shape of the toothbrush should be such that every tooth can be reached. After a thorough professional cleaning, and with maintenance of regular and meticulous oral hygiene, gum swelling and pain should decrease within one to two weeks. Maintaining strict oral hygiene must be adhered to for life or gingivitis will recur.

QUESTIONS TO ASK YOUR DOCTOR

• How serious is my gingivitis?
• What treatment is recommended?
• Will this treatment cure my condition?
• Will my gums return to normal condition?
• Will I need surgery or medication?
• If I do need surgery, what can I expect?
• If I need to take medication, what are some of the side effects I might experience?

Prognosis

After a thorough professional cleaning, and with maintenance of regular and meticulous oral hygiene, gum swelling and pain should decrease within one to two weeks. Strict oral hygiene must be adhered to for life or gingivitis will recur.

Prevention

Maintenance of strict oral hygiene, routine dental check-ups, and treatment of underlying medical conditions should prevent the occurrence and recurrence of gingivitis.

Caregiver concerns

Untreated gingivitis can progress to periodontitis which is a more severe type of gum disease. Treatment for periodontitis may require surgery. Daily oral hygiene and regular visits to the dentist can significantly reduce the risk of developing gingivitis and periodontitis.

Resources

OTHER

“Antioxidants 101.” http://www.healthcastle.com/antioxidant.shtml

“Gingivitis.” http://adam.about.com/encyclopedia/infectiousdiseases/Gingivitis.htm

“Gingivitis.” http://www.emedicine.com/

“Gingivitis.” http://www.emedicinehealth.com/

“Gingivitis.” Mayo Clinic. http://www.mayoclinic.com/

“Gingivitis.” http://www.medicinenet.com/

“Gingivitis.” http://www.merck.com/

“Gingivitis.” http://www.nlm.nih.gov/

“Gingivitis (Gum disease).” Managing your health: Health A-Z. http://www.upmc.com

“Periodontitis.” http://www.healthscout.com

June G. Borazjani R.N., M.S.N., C.P.H.Q.

GINGIVITIS

Gingivitis is a form of periodontal disease. Periodontal disease involves an inflammation and/or infection that results in the destruction of the supporting tissues of the teeth, including the gingiva (gums), the periodontal ligaments, and the tooth sockets (alveolar bone). Gingivitis is the inflammation of the gums, and often includes redness, swelling, bleeding, exudation, and sometimes pain. Gingivitis can be chronic or acute, but is usually a chronic condition.

Factors that can cause gingivitis can be either extrinsic (localized) or systemic. The most common extrinsic factor is the long-term effect of plaque deposits. "Plaque" is the sticky material that accumulates on the exposed portions of the teeth, and is composed of mucous, food debris, and bacteria. The bacteria release destructive byproducts, and unremoved plaque may mineralize into a hard deposit called "calculus" or "tartar." Plaque, the bacterial toxins, and calculus cause irritation and inflammation of the gingiva.

Injury or any irritation to the gingiva from vigorous toothbrushing, hard food, rough fillings, and mouth appliances such as dentures, can also cause gingivitis. Breathing through the mouth can also be a contributing factor.

Systemic factors, such as diseases that affect the body's immune response, hormonal changes in puberty and pregnancy, nutritional deficiencies, and diabetes mellitus, may increase the gingiva's sensitivity to irritation. Medications such as birth control pills and antiepileptic drugs, and ingestion of heavy metals such as lead and bismuth (found in some pharmaceuticals), may also exaggerate the inflammatory response.

Because gingivitis is primarily plaque-induced, good oral hygiene, including regular brushing and flossing, is the best prevention method. Calculus deposits cannot be removed by brushing alone, however, but must be removed by a dentist or dental hygienist using proper dental instruments. Gingivitis, left uncontrolled, may lead to severe periodontal disease, resulting in the loss of gingival attachments, bone, and, subsequently, teeth.

David E. Heisel

(see also: Oral Health; Plaque )

Bibliography

Grant, D. A.; Stern, I. B.; and Listgarten, M. A. (1988). Periodontics, 6th edition. St. Louis, MO: C. V. Mosby.

U.S. Department of Health and Human Services (2000). Oral Health in America: A Report of the Surgeon General. Washington, DC: U.S. Department of Health and Human Services, Public Health Service.

gin·gi·vi·tis / ˌjinjəˈvītis/ • n. Med. inflammation of the gums.