Gingivitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Gingivitis is caused by bacterial plaque (dental biofilm) that accumulates daily on the teeth.
Results in redness, slight swelling, or "puffiness" of the gums and bleeding on tooth brushing.
Treatment involves thorough professional tooth cleaning and effective daily removal of dental plaque by tooth brushing and cleaning between the teeth.
Necrotizing gingivitis is a more serious condition that is mainly found in developing countries and is associated with people with severe malnutrition or people living with HIV with low CD4 counts.

Plaque-induced gingivitis

Collection of Giuseppina Campisi, DDS, MS and Giuseppe Pizzo, DDS

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Plaque-induced gingivitis
Necrotizing gingivitis
Desquamative gingivitis secondary to oral lichen planus
Oral lichen planus (gingival mucosa shows extensive plaque-type lesions)
Desquamative gingivitis secondary to mucous membrane pemphigoid
Pemphigus vulgaris (gingival involvement)
Chronic cutaneous lupus erythematosus (gingival involvement)
Nifedipine-influenced gingival enlargement. Note also the dental decay (caries) of the upper anterior teeth
Cyclosporine-influenced gingival enlargement
Primary herpetic gingivostomatitis (gingival involvement).
Gingival allergic reaction to lipstick
Gingival enlargement, petechiae and bleeding in acute myeloid leukaemia
Primary gingival carcinoma - squamous cell carcinoma
Primary gingival carcinoma
Erythema multiforme. Gingival involvement appears as erosive oral lichen planus

Citations

Key Articles

Chapple ILC, Mealey BL, Van Dyke TE, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S74-84.[Abstract]
Farah CS, Balasumbramaniam R, McCullough MJ. Contemporary Oral Medicine. A Comprehensive Approach to Clinical Practice. 1st ed. New York, NY: Springer International Publishing; 2019.
Public Health England (PHE). Delivering better oral health: an evidence-based toolkit for prevention. 3rd ed. London: Department of Health; 2021.[Full Text]

Referenced Articles

1. Chapple ILC, Mealey BL, Van Dyke TE, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S74-84.[Abstract]
2. Lang NP, Lindhe J. Clinical periodontology and implant dentistry. 6th ed. Hoboken, NJ: Wiley-Blackwell; 2015.
3. Holmstrup P, Plemons J, Meyle J. Non-plaque-induced gingival diseases. J Periodontol. 2018 Jun;89 Suppl 1:S28-45.[Abstract]
4. Farah CS, Balasumbramaniam R, McCullough MJ. Contemporary Oral Medicine. A Comprehensive Approach to Clinical Practice. 1st ed. New York, NY: Springer International Publishing; 2019.
5. Albandar JM, Rams TE. Global epidemiology of periodontal diseases. Periodontol 2000. 2002;29:7-10.[Abstract]
6. Albandar JM, Kingman A. Gingival recession, gingival bleeding and dental calculus in adults 30 years of age and older in the United States. 1988-1994. J Periodontol. 1999 Jan;70(1):30-43.[Abstract]
7. Hugoson A, Sjödin B, Norderyd O. Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease. J Clin Periodontol. 2008 May;35(5):405-14.[Abstract]
8. Rothlisberger B, Kuonen P, Salvi GE, et al. Periodontal conditions in Swiss army recruits: a comparative study between the years 1985, 1996 and 2006. J Clin Periodontol. 2007 Oct;34(10):860-6.[Abstract]
9. Daly B, Batchelor P, Treasure ET, et al. Essential Dental Public Health. 2nd ed. Oxford, UK: Oxford University Press; 2013.
10. Wang QT, Wu ZF, Wu YF, et al. Epidemiology and preventive direction of periodontology in China. J Clin Periodontol. 2007 Nov;34(11):946-51.[Abstract]
11. Dhar V, Jain A, Van Dyke TE, et al. Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent. 2007 Apr-Jun;25(2):103-5.[Abstract][Full Text]
12. Agbelusi GA, Jeboda SO. Oral health status of 12-year-old Nigerian children. West Afr J Med. 2006 Jul-Sep;25(3):195-8.[Abstract]
13. Coelho Rde S, Gusmão ES, Jovino-Silveira RC, et al. Profile of periodontal conditions in a Brazilian adult population. Oral Health Prev Dent. 2008;6(2):139-45.[Abstract]
14. Trombelli L, Farina R, Silva CO, et al. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol. 2018 Jun;89 Suppl 1:S46-S73.[Abstract]
15. Ranganathan K, Hemalatha R. Oral lesions in HIV infection in developing countries: an overview. Adv Dent Res. 2006 Apr 1;19(1):63-8.[Abstract]
16. Albandar JM, Tinoco EM. Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000. 2002;29:153-76.[Abstract]
17. Herrera D, Alonso B, de Arriba L, et al. Acute periodontal lesions. Periodontol 2000. 2014 Jun;65(1):149-77.[Abstract]
18. Herrera D, Retamal-Valdes B, Alonso B, et al. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. J Periodontol. 2018 Jun;89 Suppl 1:S85-S102.[Abstract]
19. Coogan MM, Greenspan J, Challacombe SJ. Oral lesions in infection with human immunodeficiency virus. Bull World Health Organ 2005 Sep;83(9):700-6.[Abstract][Full Text]
20. Folayan MO. The epidemiology, etiology, and pathophysiology of acute necrotizing ulcerative gingivitis associated with malnutrition. J Contemp Dent Pract. 2004 Aug 15;5(3):28-41.[Abstract]
21. Arendorf TM, Bredekamp B, Cloete CA, et al. Seasonal variation of acute necrotizing ulcerative gingivitis in South Africans. Oral Dis. 2001 May;7(3):150-4.[Abstract]
22. Taiwo JO. Oral hygiene status and necrotizing ulcerative gingivitis in Nigerian children. J Periodontol. 1993 Nov;64(11):1071-4.[Abstract]
23. Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965 May-Jun;36:177-87.[Abstract]
24. Tanner A, Maiden MF, Macuch PJ, et al. Microbiota of health, gingivitis, and initial periodontitis. J Clin Periodontol. 1998 Feb;25(2):85-98.[Abstract]
25. Offenbacher S, Barros SP, Singer RE, et al. Periodontal disease at the biofilm-gingival interface. J Periodontol. 2007 Oct;78(10):1911-25.[Abstract]
26. Rüdiger SG, Carlén A, Meurman JH, et al. Dental biofilms at healthy and inflamed gingival margins. J Clin Periodontol. 2002 Jun;29(6):524-30.[Abstract]
27. Farina R, Guarnelli ME, Figuero E, et al. Microbiological profile and calprotectin expression in naturally occurring and experimentally induced gingivitis. Clin Oral Investig. 2011 Nov 30;16(5):1475-84.[Abstract]
28. Seymour GJ, Gemmell E, Walsh LJ, et al. Immunohistological analysis of experimental gingivitis in humans. Clin Exp Immunol. 1988 Jan;71(1):132-7.[Abstract][Full Text]
29. Gemmell E, Yamazaki K, Seymour GJ. The role of T cells in periodontal disease: homeostasis and autoimmunity. Periodontol 2000. 2007 Jan 1;43(1):14-40.[Abstract]
30. Malek R, Gharibi A, Khlil N, et al. Necrotizing ulcerative gingivitis. Contemp Clin Dent. 2017 Jul-Sep;8(3):496-500.[Abstract][Full Text]
31. Polak D, Sanui T, Nishimura F, et al. Diabetes as a risk factor for periodontal disease-plausible mechanisms. Periodontol 2000. 2020 Jun;83(1):46-58.[Abstract]
32. Figuero E, Carrillo-de-Albornoz A, Martín C, et al. Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review. J Clin Periodontol. 2013 May;40(5):457-73.[Abstract]
33. Gürsoy M, Gürsoy UK, Sorsa T, et al. High salivary estrogen and risk of developing pregnancy gingivitis. J Periodontol. 2013 Sep;84(9):1281-9.[Abstract]
34. Hugo FN, Hilgert JB, Bozzetti MC, et al. Chronic stress, depression, and cortisol levels as risk indicators of elevated plaque and gingivitis levels in individuals aged 50 years and older. J Periodontol. 2006 Jun;77(6):1008-14.[Abstract]
35. Glick A, Sista V, Johnson C. Oral manifestations of commonly prescribed drugs. Am Fam Physician. 2020 Nov 15;102(10):613-21.[Abstract]
36. Furuta M, Ekuni D, Irie K, et al. Sex differences in gingivitis relate to interaction of oral health behaviors in young people. J Periodontol. 2011 Apr;82(4):558-65.[Abstract]
37. Manicone PF, Tarli C, Mirijello A, et al. Dental health in patients affected by alcohol use disorders: a cross-sectional study. Eur Rev Med Pharmacol Sci. 2017 Nov;21(22):5021-7.[Abstract][Full Text]
38. Baghaie H, Kisely S, Forbes M, et al. A systematic review and meta-analysis of the association between poor oral health and substance abuse. Addiction. 2017 May;112(5):765-79.[Abstract]
39. Public Health England (PHE). Delivering better oral health: an evidence-based toolkit for prevention. 3rd ed. London: Department of Health; 2021.[Full Text]
40. Worthington HV, MacDonald L, Poklepovic Pericic T, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev. 2019 Apr 10;4:CD012018.[Abstract][Full Text]
41. Lamont T, Worthington HV, Clarkson JE, et al. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev. 2018 Dec 27;12:CD004625.[Abstract][Full Text]
42. Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;(6):CD002281.[Abstract][Full Text]
43. Davies R, Scully C, Preston AJ. Dentifrices - an update. Med Oral Patol Oral Cir Bucal. 2010 Nov 1;15(6):e976-82.[Abstract][Full Text]
44. Valkenburg C, Van der Weijden FA, Slot DE. Plaque control and reduction of gingivitis: The evidence for dentifrices. Periodontol 2000. 2019 Feb;79(1):221-32.[Abstract]
45. Marsh PD. Controlling the oral biofilm with antimicrobials. J Dent. 2010 Jun;38(suppl 1):S11-5.[Abstract]
46. Armitage GC. The complete periodontal examination. Periodontol 2000. 2004 Feb;34(1):22-33.[Abstract]
47. Corbet EF. Diagnosis of acute periodontal lesions. Periodontol 2000. 2004 Jan;34:204-16.[Abstract]
48. Laskaris G, Scully C. Periodontal manifestations of local and systemic diseases. Berlin: Springer-Verlag; 2003.
49. Jordan RC, Daniels TE, Greenspan JS, et al. Advanced diagnostic methods in oral and maxillofacial pathology. Part II: immunohistochemical and immunofluorescent methods. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jan;93(1):56-74.[Abstract]
50. Calabresi V, Carrozzo M, Cozzani E, et al. Oral pemphigoid autoantibodies preferentially target BP180 ectodomain. Clin Immunol. 2007 Feb;122(2):207-13.[Abstract]
51. Manfredini M, Pedroni G, Bigi L, et al. Acquired white oral lesions with specific patterns: oral lichen planus and lupus erythematosus. Dermatol Pract Concept. 2021 May 20;11(3):e2021074.[Abstract][Full Text]
52. Lo Russo L, Fedele S, Guiglia R, et al. Diagnostic pathways and clinical significance of desquamative gingivitis. J Periodontol. 2008 Jan;79(1):4-24.[Abstract]
53. Dongari-Bagtzoglou A; Research, Science and Therapy Committee, American Academy of Periodontology. Drug-associated gingival enlargement. J Periodontol. 2004 Oct;75(10):1424-31.[Abstract]
54. Leuci S, Coppola N, Adamo N, et al. Clinico-pathological profile and outcomes of 45 cases of plasma cell gingivitis. J Clin Med. 2021 Feb 18;10(4):830.[Abstract][Full Text]
55. Larsen KR, Johansen JD, Reibel J, et al. Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products. Clin Oral Investig. 2017 Nov;21(8):2543-2551.[Abstract]
56. Torgerson RR, Davis MD, Bruce AJ, et al. Contact allergy in oral disease. J Am Acad Dermatol. 2007 Aug;57(2):315-21.[Abstract]
57. Leao JC, Ingafou M, Khan A, et al. Desquamative gingivitis: retrospective analysis of disease associations of a large cohort. Oral Dis. 2008 Sep;14(6):556-60.[Abstract]
58. Torchia D, Caproni M, Fabbri P. Linear IgA disease and desquamative gingivitis: time for inclusion in mucous membrane pemphigoid. Oral Dis. 2008 Nov;14(8):768-9.[Abstract]
59. Chan LS, Ahmed AR, Anhalt GJ, et al. The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol. 2002 Mar;138(3):370-9.[Abstract]
60. Fillingim SE, Artz C, Rambhatla P. Granulomatosis with polyangiitis presenting with strawberry gums. JAMA Dermatol. 2023 May 1;159(5):554.
61. Kawakami T. New algorithm (KAWAKAMI algorithm) to diagnose primary cutaneous vasculitis. J Dermatol. 2010 Feb;37(2):113-24.[Abstract][Full Text]
62. Wiedemeyer K, Enk A, Jappe U. Erythema multiforme following allergic contact dermatitis: case report and literature review. Acta Derm Venereol. 2007;87(6):559-61.[Abstract]
63. Brazão-Silva MT, Mancusi GW, Bazzoun FV, et al. A gingival manifestation of histoplasmosis leading diagnosis. Contemp Clin Dent. 2013 Jan;4(1):97-101.[Abstract][Full Text]
64. Wheat LJ. Nonculture diagnostic methods for invasive fungal infections. Curr Infect Dis Rep. 2007 Nov;9(6):465-71.[Abstract]
65. Frater JL. How I investigate neutropenia. Int J Lab Hematol. 2020 Jun;42:121-32.[Full Text]
66. Solomou EE, Salamaliki C, Lagadinou M. How to make the right diagnosis in neutropenia. Clin Hematol Int. 2021 Feb 26;3(2):41-6.[Abstract][Full Text]
67. Berchier CE, Slot DE, Van der Weijden GA. The efficacy of 0.12% chlorhexidine mouthrinse compared with 0.2% on plaque accumulation and periodontal parameters: a systematic review. J Clin Periodontol. 2010 Sep;37(9):829-39.[Abstract]
68. Murakami S, Mealey BL, Mariotti A, et al. Dental plaque-induced gingival conditions. J Periodontol. 2018 Jun;89 Suppl 1:S17-27.[Abstract]
69. Pizzo G, Guiglia R, La Cara M, et al. The effects of an amine fluoride/stannous fluoride and an antimicrobial host protein mouthrinse on supragingival plaque regrowth. J Periodontol. 2004;75:852-857. [Erratum in: J Periodontol. 2005;76:1425.][Abstract]
70. Gunsolley JC. Clinical efficacy of antimicrobial mouthrinses. J Dent. 2010 Jun;38(suppl 1):S6-10.[Abstract]
71. Van Leeuwen MP, Slot DE, Van der Weijden GA. Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review. J Periodontol. 2011 Feb;82(2):174-94.[Abstract]
72. Feller L, Altini M, Chandran R, et al. Noma (cancrum oris) in the South African context. J Oral Pathol Med. 2014 Jan;43(1):1-6.[Abstract]
73. Araujo MW, Charles CA, Weinstein RB, et al. Meta-analysis of the effect of an essential oil-containing mouthrinse on gingivitis and plaque. J Am Dent Assoc. 2015 Aug;146(8):610-22.[Abstract][Full Text]
74. James P, Worthington HV, Parnell C, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;(3):CD008676.[Abstract][Full Text]
75. Parkinson CR, Milleman KR, Milleman JL. Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial. BMC Oral Health. 2020 Mar 26;20(1):89.[Abstract][Full Text]
76. Biesbrock A, He T, DiGennaro J, et al. The effects of bioavailable gluconate chelated stannous fluoride dentifrice on gingival bleeding: Meta-analysis of eighteen randomized controlled trials. J Clin Periodontol. 2019 Dec;46(12):1205-1216.[Abstract][Full Text]