Doctors Revision

Oral & Dental Health

Gingivitis (Chronic)

Inflammation of the gingiva (gums) primarily caused by accumulation of dental plaque along the gumline.

Also known as: Gum Inflammation

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Referral and warning signs

When to refer

Refer to dental personnel (HC4+) for professional cleaning (scaling/polishing) and oral hygiene instruction. Refer if gingival enlargement present (medication-related?) or if periodontitis suspected.

Red flags

  • Significant gum recession.
  • Tooth mobility.
  • Deep periodontal pockets (>4mm).
  • Signs of acute infection (ANUG).

Signs and symptoms

  • Redness and swelling of the gingival margins.
  • Bleeding gums (especially during brushing, flossing, or gentle probing).
  • Gums may be tender.
  • Bad breath (halitosis).
  • No loss of periodontal attachment (bone loss) - distinguishes from periodontitis.
  • Visible plaque and calculus (tartar) deposits.

Risk factors

  • Poor oral hygiene (inadequate brushing/flossing).
  • Plaque accumulation.
  • Hormonal changes (puberty, pregnancy, menstruation).
  • Certain medications (e.g., phenytoin, calcium channel blockers, cyclosporine - can cause gingival enlargement).
  • Systemic diseases (e.g., uncontrolled diabetes).
  • Smoking.
  • Malnutrition (esp. Vitamin C deficiency - rare).

Diagnosis

Clinical assessment

Based on clinical examination showing signs of inflammation (redness, swelling, bleeding on probing) localized to the gingiva, with presence of plaque/calculus, and NO evidence of attachment loss (no deep pockets).

Investigations

  • Dental examination.
  • Periodontal probing (pocket depths generally <3-4mm, no attachment loss).

Diagnostic criteria

Clinical signs of gingival inflammation (redness, swelling, bleeding) without loss of periodontal attachment.

Management

Non-pharmacological management

  • Improved Oral Hygiene (Mainstay):
  • - Thorough tooth brushing twice daily with fluoride toothpaste.
  • - Daily interdental cleaning (flossing or interdental brushes).
  • Professional Dental Cleaning:
  • - Scaling and polishing to remove plaque and calculus deposits (tartar). (LOC: HC4+)

Pharmacological treatment

  • Antiseptic Mouthwashes: (Adjunct to mechanical cleaning, not replacement)
  • - Chlorhexidine gluconate 0.12% or 0.2% mouthwash BID for short periods (1-2 weeks) can reduce plaque/gingivitis. (LOC: HC2+)
  • - Warm salt water rinses (1/2 tsp salt in glass warm water) TID. (LOC: HC2)
  • - Hydrogen peroxide 3% diluted 1:1 with water (or 6% diluted 1:4) rinse TID (short term). (LOC: HC2)
  • Systemic Antibiotics: NOT indicated for chronic gingivitis unless associated with systemic signs (rare) or specific aggressive forms (ANUG - see ODH014).

Monitoring

Re-evaluate oral hygiene practices and gingival health at follow-up dental visits.

Complications

  • If untreated, can progress to periodontitis (attachment loss, bone loss, tooth loss).
  • Persistent bleeding, discomfort, halitosis.

Prevention

  • Meticulous daily oral hygiene (brushing, flossing).
  • Regular professional dental cleanings.
  • Control systemic risk factors (diabetes, smoking).

Patient education

  • Explanation of gingivitis as reversible gum inflammation caused by plaque.
  • Demonstration of proper brushing and flossing techniques.
  • Importance of regular professional cleanings.
  • Role of mouthwashes as adjuncts.
  • Connection between oral health and systemic health (e.g., diabetes).

Uganda-specific notes

Very common due to varying levels of oral hygiene practice. Focus on patient education for brushing/flossing and referral for scaling.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 23, Section 23.2.5, 23.2.5.1

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