Gingivitis Clinical Presentation

  • Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: May 8, 2012
 

History

Historical findings depend on whether the patient has chronic gingivitis or ANUG.

  • Chronic gingivitis
    • The most common complaint is bleeding gums. The patient usually notices this when toothbrushing or flossing.
    • Bleeding may be associated with eating, especially foods with a hard consistency, such as apples or crusted bread. These foods may rub against gums.
  • Acute necrotizing ulcerative gingivitis
    • Apparently spontaneous bleeding or bleeding in response to very minimal local trauma may occur.
    • ANUG also may produce local pain, malaise, and alterations in taste, such as a metallic flavor.
    • ANUG may produce foul breath.
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Physical

  • Chronic gingivitis
    • Patients have minimal physical findings aside from local findings at the dental-gingival margins.
    • Gingival pockets may be detected with a periodontal probe. However, the pocket depth may be overestimated when periodontitis is present and underestimated in healthy gums.
    • Mild bleeding from the gum margins may occur with any manipulation.
  • Acute necrotizing ulcerative gingivitis
    • Fever, halitosis, marked gingival edema, and ulceration, especially in the interdental papillae, may be present.
    • A grey pseudomembrane may be present.
    • Infection may spread to adjacent soft tissues of the mouth, with noticeable erythema, edema, tenderness, and induration of affected areas.
  • Reaction to oral contraceptives (see Causes)
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Causes

  • Although bacteria play a role in all forms of gingivitis, the primary cause of chronic gingivitis is inadequate oral hygiene.
  • Risk factors
    • Use of tobacco or ethanol is thought to be a risk factor.
    • Immune incompetence is observed more frequently in HIV-infected children. As their CD4 counts decline, incidence of gingivitis may increase. Diabetes mellitus increases the risk of gingivitis and periodontitis.
  • Drug-induced causes
    • The list of drugs that cause gingivitis and gingival bleeding is extensive.
    • Gingival bleeding may occur with the use of anticoagulants and fibrinolytic agents.
    • Phenytoin, oral contraceptive agents, and calcium channel blockers may cause gingival hyperplasia.
    • Gingivitis has been observed with use of protease inhibitors (eg, saquinavir, ritonavir), vitamin A and analogues, danazol, pentamidine, misoprostol, methotrexate, and gold compounds.
    • Gingivostomatitis has been observed in exposure to arsenic, gold, bismuth, mercury, nickel, sulfur dioxide, lead, thallium, zinc, methyl violet, and topical chlorhexidine.
  • Acute necrotizing ulcerative gingivitis
    • Acute necrotizing infection may occur as a complication of chronic gingivitis in situations in which hygiene is abandoned completely or host defenses are weakened.
    • ANUG is the result of soft tissue invasion by ubiquitous organisms and is not believed to be contagious.
    • It is a risk wherever poor sanitation, diet, or oral hygiene is present.
    • Living near livestock is an additional risk factor.
  • Other causes
    • Inadequate plaque removal
    • Blood dyscrasias
    • Allergic reactions
    • Chronic debilitating disease
    • Poor nutrition
    • Lack of periodic dental examinations
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Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

James M Stephen, MD, FAAEM, FACEP  Assistant Professor, Tufts University School of Medicine; Attending Physician, Director of Medical Informatics and Graduate Education, Department of Emergency Medicine, Tufts Medical Center

James M Stephen, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Glick, DMD  Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM  Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Special thanks to Robert J. Lindberg, DMD, for images and excellent dental care.

The authors and editors of Medscape Reference gratefully acknowledge the medical review of this article by Tyson Pillow, MD.

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Healthy mouth and gingiva. Note the healthy light pink color of the gingiva. The intradental papillae are sharp and fill the intradental space. No local edema is present. Image courtesy of Robert J. Lindberg, DMD.
Moderate chronic gingivitis. Note that the papillae are edematous and blunted. They may bleed with brushing. Note areas of edema overlying some of the root areas. Pallor is seen in these areas. Image courtesy of Robert J. Lindberg, DMD.
Severe periodontal disease. Loss of the gingival tissue is seen, making the teeth appear long. Even more effacement of the papillae is present. Heaped up ridges are observed in the areas overlying the roots. Image courtesy of Robert J. Lindberg, DMD.
 
 
 
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