Gingivitis

Gingivitis presentation

1. Gingivitis Presented by : SANJU SAH ST. XAVIER’S COLLEGE, MAITIGHAR, KATHMANDU DEPARTMENT OF MICROBIOLOGY

2. Gingivitis Gingivitis means inflammation of the gum tissue or gingiva. Gingivitis may be localized to one or more specific sites in mouth or can occur in a generalized form. It commonly occurs because of a film of plaque, or bacteria that accumulates on the teeth . Gingivitis can lead to much more serious gum disease called periodontitis and tooth loss. Signs includes red and puffy gums, that bleed easily while brushing . Often resolves with good oral hygiene, such as longer and more frequent brushing, and flossing and use of antiseptic mouth.

3. Types- On the basis of plaque formation  Two main categories of gingival diseases. They are Dental plaque-induced gingival disease: It is caused by plaque, systemic factors, medications, or  malnutrition Non-plaque induced gingival lesions: It is caused by a specific bacterium, virus, or fungus. It might also be caused by genetic factors, systemic conditions (including allergic reactions and certain illnesses), wounds, or reactions to foreign bodies, such as dentures. Sometimes, there is no specific cause.

4. On the basis of course Acute gingivitis Recurrent gingivitis Chronic gingivitis Acute gingivitis: it is of sudden onset and short duration and can be painful A less severe form of acute condition is called sub-acute . 2. Recurrent gingivitis: Reappears after eliminated by a treatment or disappearing spontaneously.

5. Contd … 3. Chronic gingivitis: slow in onset and long duration Is painless Inflammation persists or resolves and normal areas become inflamed.

6. Causes Most common cause of gingivitis is the accumulation of bacterial plaque, triggers an immune response that can eventually lead to the destruction of gingival, or gum tissue . Current research shows that activity levels of the following enzymes in saliva samples are associated with periodontal destruction: aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and acid phosphatase (ACP). Therefore, these enzyme biomarkers may be used to aid in the diagnosis and treatment of gingivitis and periodontitis.

7. Other causes and risk factors Changes in hormones:   This may occur during puberty, menopause, the menstrual cycle, and pregnancy. The gingiva might become more sensitive, raising the risk of inflammation . Some diseases:   Cancer, diabetes, and HIV are linked to a higher risk of gingivitis. Smoking:   Regular smokers more commonly develop gingivitis, compared with non-smokers . Age:   The risk of gingivitis increases with age Poor diet:   vitamin-C deficiency, is linked to gum disease . Family history:   Those whose parent or parents have had gingivitis have a higher risk of developing it too. This is thought to be due to the type of bacteria we acquire during our early life.

8. Signs and symptoms Bright red or purple gums Tender gums that may be painful to the touch Bleeding from the gums when brushing or flossing Receding gumline Halitosis or bad breath Inflammation, swollen gums/ soft gums

9. Laboratory Diagnosis Usually diagnosis is based on medical history, examination . In a good light, inside of mouth is examined for any ulcerations, spots, exudates, inflammation. Checking for signs of periodontitis may also be recommended. This may be done by X-ray or periodontal probing, using an instrument that measures pocket depths around a tooth . Specimens for microscopy and culture: Pus collected by needle and syringe, swab samples( sterile cotton or alginate swab) Swab should be free of contamination from saliva.

10. At least before 8 hours of sample collection, before use of antibiotics or antiseptic mouth washes/gargles . The specimen should be processed within 2 hours of collection . For the GCF(Gingival crevicular fluid) collection, most commonly used devices are strips of filter paper and micropipettes . Direct microscopy: it reveals pus cells and bacteria. Culture : Specimens are inoculated on blood agar Incubate anaerobically / Co2 enriched medium at 37ºc for overnight.

11. For the detection of S. pyogens , bacitracin disc may be placed in primary inoculum . To identify isolates, gram staining and further biochemical test is performed. For the suspection of fungal isolates, should be inoculated into SDA Anaerobic culture technique: is an open test system. It is most extensive technique to study the composition of Supra an sub-gingival plaque. Other tests: ELISA PCR Enzyme test

12. Treatment If diagnosis happens early, and if treatment is prompt and proper, gingivitis can be successfully reversed. Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home . Professional dental care: Plaque and tartar are removed. This is known as scaling. This can be uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive .

13. Follow-up appointments may be recommended, with more frequent cleanings, if necessary. Fixing any damaged teeth also contributes to oral hygiene. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar. They may also irritate the gums. Care at home: Brush teeth at least twice a day. Use an electric toothbrush. Floss teeth at least once a day. Regularly rinse mouth with an antiseptic mouthwash.

14. Complications If delay treatment , gum disease can spread and affect tissue, teeth, and bones . Abscess or infection in the gingiva or jaw bone . Periodontitis, a more serious condition that can lead to loss of bone and teeth . The bacteria responsible for periodontitis can enter your bloodstream through gum tissue, possibly affecting your heart, lungs and other parts of your body. Chronic gingiva inflammation has been thought to be associated with some systemic diseases such as respiratory disease, diabetes, coronary artery disease, stroke and rheumatoid arthritis . Trench mouth, also known as necrotizing ulcerative gingivitis (NUG), is a severe form of gingivitis that causes painful, infected, bleeding gums and ulcerations.

15. References https://www.medicalnewstoday.com/articles/241721.php https:// www.mayoclinic.org/diseases-conditions/gingivitis/diagnosis-treatment/drc-20354459 http://shelbourneclinic.ie/advice/gum-disease / https://www.ncbi.nlm.nih.gov/books/NBK279593/

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