The most common complaint of patients with gingivitis is the bleeding gums, which he notices while eating, brushing or flossing. In patients with ANUG, spontaneous bleeding is observed even after minimal local trauma. ANUG also causes local pain, malaise and altered taste with bad breath.

Laboratory testing does not help to diagnose gingivitis. However, if a systemic disease or toxin is suspected, laboratory tests are recommended. Generally, imaging studies are not indicated in patients with gingivitis [6].

Intervention from emergency department (ED) is generally not called for in patients with chronic gingivitis. Pain management is the requirement for patients with ANUG in the ED. In rare cases, fever and sepsis following the destruction of the soft tissue are observed in the patients with gingivitis. In such patients, intravenous antibiotics therapy is initiated.

The dentist must stress on the importance of oral care. The dentists remove the plaque, and calculus to avoid progression of the disease. He may advise to clean the mouth with warm saline water. Use of fluoride dentifrice, electric toothbrush and regular flossing will slow the progression of the disease. Some studies have concluded that brushing followed by rinsing with chlorhexidine also yield good results.

Some of the medications used in the management of gingivitis are non-steroidal anti-inflammatory drugs (such as ibuprofen, acetaminophen with codeine), local anesthetics and antibiotics. Antibiotics eradicate the bacterial infections in the patients with ANUG. NSAIDs and topical xylocaine for pain relief are also prescribed for patients with chronic gingivitis and ANUG. Penicillin V, erythromycin, minocycline (used as an adjunct to scaling), doxycycline, and clindamycin are some of the common antibiotics that are used to manage ANUG. Chlorhexidine has bactericidal activity and is helpful in combating the progression of the disease. Topical anesthetics such as lidocaine can help in controlling the pain and allows the patient to brush and floss without trauma [7] [8] [9].

If gingivitis is not treated, it can lead to tooth loss; however, with initial cleaning and scaling, gingivitis can be reverse and the patients respond well with appropriate treatment. Management of patients with ANUG requires the aggressive treatment with antibiotics. Patient with intact host defenses often respond well to treatment.

Inadequate oral hygiene is the primary cause of the chronic gingivitis. Other risk factors of this disease are smoking, use of tobacco, alcohol, patients with compromised immune system (diabetes, HIV/AIDS), and periodontitis. Diabetes mellitus, blood dyscrasias, inadequate removal of plaque, allergic reactions, poor nutrition, and lack of dental examination increases the chance of gingivitis several fold.

Gingivitis can also be caused by some drugs such as anticoagulants, fibrinolytic agents, oral contraceptives, phenytoin, danazol, vitamin A and its analogues, calcium channel blockers and protease inhibitors. Acute necrotizing ulcerative gingivitis (ANUG) is a complication of chronic gingivitis with poor or abandoned hygiene and weak host defenses. ANUG is not contagious and is caused as a result of invasion by ubiquitous organisms of the soft tissue [2].

In developed countries such as Australia, Sweden, Switzerland and England 48 to 85% of the children (ages between 3 and 6 years) have reported gingivitis. Among adolescents, the incidence of gingivitis across the world range between 50% and 90%. ANUG is common in regions which face poor living conditions. Gingivitis can cause health-issues in the patients. In some studies, the periodontal disease may be one of the factors of coronary artery disease or ischemic stroke.

The elevated levels of the markers of the chronic inflammation (C-reactive protein) fall after the treatment of the periodontal disease. Chronic gingivitis may lead to tooth loss. In patients with type-2 diabetes, gingivitis can be managed well by improved glycemic control. During pregnancy, periodontal disease is often associated with preterm birth and adverse pregnancy outcomes. Gingivitis is relatively more prevalent in males than females [3] [4] [5].

Accumulation of the microbial plaque due to inadequate oral hygiene, leads to the development of gingivitis. The initial stages of gingivitis (which begins within 4 or 5 days of formation of plaque) manifest as lesions which later progresses to advanced disease. With time, gingival fluid and increase of migration of neutrophils to the site is seen. In the initial stage itself, there is a deposition of fluid and the destruction of the collagen.

After 1 week, the infiltration of lymphocytes to the site occurs. With time, the lesions become chronic and are often characterized by the presence of the B lymphocytes and plasma cells. Bleeding during brushing or even chewing is also observed. Persistent inflammation leads to the breakdown and destruction of the local alveolar bone, loosening the teeth.

ANUG, on the other hand, is caused by the acute infection of the gingiva with Actinomyces species, alpha-hemolytic streptococci or Prevotella intermedia. ANUG leads to accelerated destruction of the affected tissues [1] [2].

Gingivitis and ANUG can be prevented by having a good oral hygiene, and regular dental check-up.

Inflammation which is limited to the mucosal epithelial tissues and which surrounds the cervical portion of the teeth and the alveolar processes is referred to as gingivitis. Depending on the clinical appearance, etiology and duration, gingivitis is classified. The most common chronic gingivitis is caused by plaque. [1]

Definition

Gingivitis is the inflammation of the gums due to bacteria which is present in the deposition of plaque buildup. Irritation and gum bleeding is common in patients with gingivitis.

Cause

Gingivitis is caused due to poor oral hygiene. Other risk factors of gingivitis are smoking, alcohol and diseases such as diabetes and HIV/AIDS (which impairs the immune system). Some medications such as anticoagulants, fibrinolytic agents, phenytoin and oral contraceptives can also contribute to the progression of gingivitis.

Symptoms

Symptoms of gingivitis are gum-bleeding, pain and swelling of the gums. 

Diagnosis

Diagnosis of gingivitis can be done by observing the oral cavity by a dentist. If the systemic disease is suspected, laboratory tests are recommended.

Treatment

Treatment of gingivitis involves use of painkillers such as ibuprofen and local anesthetics (lidocaine). The patient must also be advised about the advantages of having proper oral hygiene to combat the bacteria. 

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