Gingivitis Follow-up

Updated: Jan 18, 2018
  • Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Follow-up

Further Outpatient Care

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  • 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.

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Deterrence/Prevention

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  • Good oral hygiene: The use of a power toothbrush with rotating/oscillating motion is better than a manual brush.

  • Regular dental check-ups

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Complications

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  • 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.

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Prognosis

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  • 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.

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Patient Education

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  • 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. [28, 29]

  • Certain toothpastes, both herbal and non-herbal, have additional benefit.

  • For excellent patient education resources, visit eMedicineHealth's Oral Health Center. Also, see eMedicineHealth's patient education articles Gingivitis, Periodontal (Gum) Disease, and When to Visit the Dentist.

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