Gingivitis Follow-up

  • Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM   more...
 
Updated: Apr 12, 2010
 

Further Outpatient Care

  • Patients with simple chronic gingivitis should be given nonurgent dental referral.
  • Patients with ANUG should be seen within 24-48 hours for reevaluation because of risk of local or systemic spread of infection.
  • In addition to antibiotic therapy, physical and mental stressors should be eliminated. Good oral hygiene is mandatory.
Next

Deterrence/Prevention

  • Good oral hygiene: The use of a power toothbrush with rotating/oscillating motion is better than a manual brush.
  • Regular dental check-ups
Previous
Next

Complications

  • Gingivitis is not a direct significant threat to the health of a healthy individual, but it can contribute to illness and cause local and systemic complications.
  • ANUG that progresses to noma is associated with a mortality rate as high as 70% without proper antibiotics and debridement.
  • The most common complication of chronic gingivitis is progression to periodontal disease and tooth loss. Areas of chronic gingivitis may predispose the individual to the development of odontogenic abscesses by allowing a route of bacterial invasion into the periodontal space from the gingival pocket. ANUG may be locally destructive and may result in local spread of infection into the surrounding tissues (Vincent angina and noma [cancrum oris]). Potential also exists for systemic spread of infection.
  • Osteomyelitis of alveolar bone may arise but is uncommon.
  • Any dental procedures involving manipulation that causes bleeding may result in endocarditis. The presence of gingivitis increases this risk by making the gingiva more likely to bleed with simple manipulation (eg, dental scaling). Bacteria containing plaque accumulation in the gingival pockets are in direct proximity to the areas of disrupted gingiva, increasing the likelihood of bacteria escaping into the general circulation.
Previous
Next

Prognosis

  • Untreated chronic gingivitis eventually results in tooth loss.
  • After an initial cleaning and scaling in its early stages, gingivitis usually is reversible with good dental hygiene.
  • ANUG responds to treatment if host defenses are intact. Noma requires aggressive treatment with antibiotics and local debridement.
  • The usual course is acute, relapsing, intermittent, and chronic.
  • Gingivitis generally responds well to appropriate treatment.
Previous
Next

Patient Education

  • Good oral hygiene, including brushing and flossing, treats and prevents chronic gingivitis. If flossing is too much of a bother, then plaque-reducing rinses, used daily, have proven benefit.
  • Studies show electric toothbrushes to be more effective than manual brushes in preventing gingivitis.[15, 16]
  • Certain toothpastes, both herbal and nonherbal, have additional benefit.
  • For excellent patient education resources, visit eMedicine's Teeth and Mouth Center. Also, see eMedicine's patient education articles Gingivitis, Periodontal (Gum) Disease, and When to Visit the Dentist.
Previous
 
Contributor Information and Disclosures
Author

James M Stephen, MD, FAAEM, FACEP  Assistant Professor, Tufts University School of Medicine; Attending Physician and Director of Medical Informatics, Department of Emergency Medicine, Associate Director, Kiwanis Pediatric Trauma Service, 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  Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey

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  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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.

References

  1. Idigbe EO, Enwonwu CO, Falkler WA, et al. Living conditions of children at risk for noma: Nigerian experience. Oral Dis. Apr 1999;5(2):156-62. [Medline].

  2. Dorfer CE, Becher H, Ziegler CM, et al. The association of gingivitis and periodontitis with ischemic stroke. J Clin Periodontol. May 2004;31(5):396-401. [Medline].

  3. Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA. Sep 20 2000;284(11):1406-10. [Medline].

  4. Wu T, Trevisan M, Genco RJ, et al. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med. Oct 9 2000;160(18):2749-55. [Medline].

  5. Bobetsis YA, Barros SP, Offenbacher S. Exploring the relationship between periodontal disease and pregnancy complications. J Am Dent Assoc. Oct 2006;137 Suppl 2:7S-13S. [Medline].

  6. Persson R, Hitti J, Verhelst R, Vaneechoutte M, Persson R, Hirschi R, et al. The vaginal microflora in relation to gingivitis. BMC Infect Dis. Jan 22 2009;9:6. [Medline]. [Full Text].

  7. Mealey BL. Periodontal disease and diabetes: A two-way street. J Am Dent Assoc. Oct 2006;137 Suppl 2:26S-31S. [Medline].

  8. Perez A, Wagner AM, Carreras G, et al. Prevalence and phenotypic distribution of dyslipidemia in type 1 diabetes mellitus: effect of glycemic control. Arch Intern Med. Oct 9 2000;160(18):2756-62. [Medline].

  9. Kardesler L, Buduneli N, Cetinkalp S, Kinane DF. Adipokines and inflammatory mediators after initial periodontal treatment in patients with type 2 diabetes and chronic periodontitis. J Periodontol. Jan 2010;81(1):24-33. [Medline].

  10. Lorenz K, Bruhn G, Heumann C, et al. Effect of two new chlorhexidine mouthrinses on the development of dental plaque, gingivitis, and discolouration. A randomized, investigator-blind, placebo-controlled, 3-week experimental gingivitis study. J Clin Periodontol. Aug 2006;33(8):561-7. [Medline].

  11. Zimmer S, Kolbe C, Kaiser G, et al. Clinical efficacy of flossing versus use of antimicrobial rinses. J Periodontol. Aug 2006;77(8):1380-5. [Medline].

  12. Triratana T, Rustogi KN, Volpe AR, et al. Clinical effect of a new liquid dentifrice containing triclosan/copolymer on existing plaque and gingivitis. J Am Dent Assoc. Feb 2002;133(2):219-25. [Medline].

  13. Taiyeb Ali TB, Waite IM. The effect of systemic ibuprofen on gingival inflammation in humans. J Clin Periodontol. Nov 1993;20(10):723-8. [Medline].

  14. Johnson RH, Armitage GC, Francisco C, Page RC. Assessment of the efficacy of a nonsteroidal anti-inflammatory drug, Naprosyn, in the treatment of gingivitis. J Periodontal Res. Jul 1990;25(4):230-5. [Medline].

  15. Cronin M, Dembling W, Warren PR, King DW. A 3-month clinical investigation comparing the safety and efficacy of a novel electric toothbrush (Braun Oral-B 3D Plaque Remover) with a manual toothbrush. Am J Dent. Sep 1998;11(Spec No):S17-21. [Medline].

  16. Forrest JL, Miller SA. Manual versus powered toothbrushes: a summary of the Cochrane Oral Health Group's Systematic Review. Part II. J Dent Hyg. Spring 2004;78(2):349-54. [Medline].

  17. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J. Nov 2007;154(5):830-7. [Medline].

  18. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. 6th ed. Lippincott Williams & Wilkins; 2001.

  19. Estafan D, Gultz J, Kaim JM, et al. Clinical efficacy of an herbal toothpaste. J Clin Dent. 1998;9(2):31-3. [Medline].

  20. Falkler WA Jr, Enwonwu CO, Idigbe EO. Microbiological understandings and mysteries of noma (cancrum oris). Oral Dis. Apr 1999;5(2):150-5. [Medline].

  21. Gaspar L, Suri C, Toth BZ, et al. [Experience with clindamycin in stomatologic diseases]. Fogorv Sz. Aug 1999;92(8):251-8. [Medline].

  22. Gehlen I, Netuschil L, Georg T, et al. The influence of a 0.2% chlorhexidine mouthrinse on plaque regrowth in orthodontic patients. A randomized prospective study. Part II: Bacteriological parameters. J Orofac Orthop. 2000;61(2):138-48. [Medline].

  23. Greenspan JS. Oral manifestation of disease. In: Fauci, et al, eds. Harrison's Principles of Internal Medicine. 13th ed. McGraw Hill; 1994:199-200.

  24. Guggenheimer J, Eghtesad B, Close JM, Shay C, Fung JJ. Dental health status of liver transplant candidates. Liver Transpl. Feb 2007;13(2):280-6. [Medline].

  25. Howell RB, Jandinski JJ, Palumbo P, et al. Oral soft tissue manifestations and CD4 lymphocyte counts in HIV-infected children. Pediatr Dent. Mar-Apr 1996;18(2):117-20. [Medline].

  26. Lamster IB, Grbic JT, Mitchell-Lewis DA, et al. New concepts regarding the pathogenesis of periodontal disease in HIV infection. Ann Periodontol. Jul 1998;3(1):62-75. [Medline].

  27. Ranney RR. Diagnosis of periodontal diseases. Adv Dent Res. Dec 1991;5:21-36. [Medline].

  28. Robinson PJ. Gingivitis: a prelude to periodontitis?. J Clin Dent. 1995;6 Spec No:41-5. [Medline].

  29. Sculley DV, Langley-Evans SC. Salivary antioxidants and periodontal disease status. Proc Nutr Soc. Feb 2002;61(1):137-43. [Medline].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.