Chronic gingivitis
Credit: knowltondental

What is Chronic Gingivitis?

Gingivitis is the inflammation of the Gingival Tissue without involving tooth supporting tissue, periodontal ligament or bone. Chronic gingivitis is asymptomatic, low grade inflammation of the gingiva, induced by bacterial plaque growing along the gingival margin.

Classification of Chronic Gingivitis

Dental plaque Induced Chronic Gingivitis:

  1. Gingivitis associated with dental plaque only A. Without Local Contributing Factors
  2. With Local Contributing Factors
  3. Gingival Disease modified by systemic factors 3. Gingival Disease Modified by Medication
  4. Gingival Disease Modified by Malnutrition

Non Plaque Induced Chronic Gingivitis:

  1. Gingival disease of specific bacterial origin 2. Gingival disease of viral origin
  2. Gingival disease of fungal origin 4. Gingival disease of genetic origin
  3. Gingival manifestation of Systemic Condition 6. Traumatic Lesions
  4. Foreign Body Reactions

According to Severity:

  1. Mild Chronic Gingivitis
  2. Moderate Chronic Gingivitis
  3. Severe Chronic Gingivitis

According to Distribution:

  1. Localized Chronic Gingivitis
  2. Generalized Chronic Gingivitis

Etiological Factors:

  1. Poor tooth cleaning technique
  2. Malocclusion
  3. Mouth Breathing
  4. Dry Mouth
  5. Changes in hormone
  6. Puberty
  7. Pregnancy

Clinical Features:

  1. Color of gingiva : Starts as light redness, later reddish blue & deep blue.
  2. Gingival contour : Marginal gingiva appears rounded with blunted inter dental papilla.
  3. Gingival consistency : Soft and spongy to firm
  4. Gingival texture : A reduction in stripping is seen.
  5. Tendency to bleed : Bleeding on instrumentation and brushing.
  6. Deposition of supra & subgingival calculus.
  7. Inflammation of gingiva without attachment or bone loss
  8. Pocket depth: Increased sulcular depth.
  9. Halitosis.
  10. Marginal ulceration also seen

Pathology of Chronic Gingivitis:

StagesVascular ChangesMicroscopic ChangesClinical changes
  1. Initial lesion (2-4 Days)
Classical visualities subjacent to junctional epitheliumPresence of Leucocytes(PMNs). Los of perivascular collagen, Changes in the coronal most portion of the junctional epitheliumExudation of fluid from the Gingival Sulcus, Subclinical Gingivitis
2. Early lesion (4-7 Days)Vascular ProliferationRete Peg Formation in junctional Epithelium, Presence of Lymphocytes, Loss of collagen, Fibroblasts show cytoplasmic alternationErythematous, Gingival Bleeding on Probing

 

StagesVascular ChangesMicroscopic ChangesClinical changes
3. Established lesion (4-7 days)Same as early lesion,with blood stasisProliferation, apical migration &lateral extension of junctional epithelium, atrophic areas, plasma cells are predominant, further loss of collagen, increased enzyme levels such as acid and alkaline phosphatase, beta glucuronidase etc.Changes seen in consistency & surface texture.

Bluish he around the reddened gingiva

4. Advanced lesionSame as early & established lesionPersistence of features seen in established lesion. Extension of inflammation into deeper structures, presence of all types of inflammatory cellsFormation of periodontal pocket

Diagnosis:

  • Bleeding on Probing (BOP): Positive •Supra or Subgingival Calculus and Plaque
  • Investigation: OPG

Treatment Plan:

Phase 1: Conservative and Non Surgical:

1.Patient education and oral hygiene instruction of:

  • Effective toothbrushing.
  • Interdental cleaning habits.
  • Plaque Control with Chlorohexidine mouthwash

2.Removal of supra and subgingival plaque and calculus by scaling and polishing.

3. Curettage

Phase 2: Evaluation of response to therapy by follow up

  • Gingival inflammation •Plaque and calculus
  • Treatment of carious lesion(if any) contribution to plaque accumulation

Phase 3: Maintenance

  • Recall visit after 3 weeks/6 weeks, 3 month, 6 months and onward(twice a year) based on plaque accumulation
  • Patients co-operation to check patient whether he/she maintained hygiene or not.

Prevention of chronic gingivitis:

  • Elimination of etiological factors.
  • Maintenance of plaque control consistent with gingival
  • Effective removal of supragingival & subgingival calculus
  • Correction of dental & prosthetic restoration.
  • Intake of nutritionally adequate diet with reduction of
  • Performance of orthodontics when indicated

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