GINGIVITIS

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Gingivitis is simply defined as the inflammation of the gum (gingivae) caused by microbial activity. It is the redness and swelling of the gingival tissues or gum as a result of bacterial infection. Gingivitis is mediated or caused by oral bacteria including Fusobacterium species, Bacteroides, Entamoeba gingivalis, Prevotella species, Bacillus intermedius, Capnocytophaga species, Veillonella speciesand Actinomyces species. The microorganism’s responsible for initiating gingivitis release toxins and enzymes, which can bring about immunological response that culminate to the inflammation of the gingivae (gum). Gingivitis can be acute or chronic in occurrence depending on the level of the microbial infection, and it does not bring about a permanent loss or destruction of any of the dental structures as is applicable in other forms of dental infection such as in periodontitis or dental caries (decay) that may cause a permanent loss or destruction of any of the dental structures.

The clinical features of chronic gingivitis include swelling of the gum, bleeding of the gum, halitosis, and change in the colour of the teeth. Chronic gingivitis does not usually result in the movement of the teeth, and affected patients rarely experience tooth ache. Acute gingivitis unlike chronic gingivitis (whose clinical episodes last for a very long time) occurs sporadically and it is usually severe and does not lead to a protracted illness in the affected individual. Acute traumatic gingivitis (ATG), acute necrotizing gingivitis (ANG), and acute allergic gingivitis (AAG) are the major forms of acute gingivitis in humans. While acute traumatic gingivitis (ATG) usually arises as a result of a trauma/injury to the gingivae (gum), the acute necrotizing gingivitis (ANG) normally occurs in patients whose immune system has been compromised.

Oral bacteria in the oral cavity of patients with compromised immune system can easily become pathogenic and cause acute necrotizing gingivitis. ATG can also occur by using hard tooth brush to brush the teeth especially one that is too tough and can cause damage to the gingivae. The unnecessary use of hot water can also predispose an individual to developing ATG. Acute traumatic gingivitis is self-limiting and thus the dental condition can heal with time without any prior medication or visit to the dentist or dental clinic for medical attention. Acute allergic gingivitis (AAG) is usually caused by hypersensitivity reactions of the teeth that may be due to the constituents of the type of tooth pastes used or other cosmetics that enters the oral cavity. AAG can cause oral ulceration such as glossitis (inflammation of the surface of the tongue) and cheilitis (inflammation of the lips). 

Further reading

Brooks G.F., Butel J.S and Morse S.A (2004). Medical Microbiology, 23rd edition. McGraw Hill Publishers. USA.

Gilligan P.H, Shapiro D.S and Miller M.B (2014). Cases in Medical Microbiology and Infectious Diseases. Third edition. American Society of Microbiology Press, USA.

Madigan M.T., Martinko J.M., Dunlap P.V and Clark D.P (2009). Brock Biology of Microorganisms, 12th edition. Pearson Benjamin Cummings Inc, USA.

Mahon C. R, Lehman D.C and Manuselis G (2011). Textbook of Diagnostic Microbiology. Fourth edition. Saunders Publishers, USA.

Patrick R. Murray, Ellen Jo Baron, James H. Jorgensen, Marie Louise Landry, Michael A. Pfaller (2007). Manual of Clinical Microbiology, 9th ed.: American Society for Microbiology.

Wilson B. A, Salyers A.A, Whitt D.D and Winkler M.E (2011). Bacterial Pathogenesis: A molecular Approach. Third edition. American Society of Microbiology Press, USA.

Woods GL and Washington JA (1995). The Clinician and the Microbiology Laboratory. Mandell GL, Bennett JE, Dolin R (eds): Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone, New York.

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