The most common complaint of patients with gingivitis is the bleeding gums, which he notices while eating, brushing or flossing. In patients with ANUG, spontaneous bleeding is observed even after minimal local trauma. ANUG also causes local pain, malaise and altered taste with bad breath.

• Inflammation

  Overview Gingivitis is a common and mild form of gum disease (periodontal disease) that causes irritation, redness and swelling (inflammation) of your gingiva, the part of your gum around the base of your teeth. [mayoclinic.org]

  You can also decrease the inflammation and pain of gingivitis while helping your body fight the infection. [livestrong.com]

  Persistent inflammation leads to the breakdown and destruction of the local alveolar bone, loosening the teeth. [symptoma.com]

• Dentist

  Check with your dentist or physician before using it. [yourdentistryguide.com]

  The dentist checks the shape and color of gingival tissue on the buccal (cheek) side and lingual (tongue) side of each tooth. [news-medical.net]

  […] an appointment with your dentist. [mayoclinic.org]

  Your dentist may advise you not to eat, drink or brush your teeth for two hours after using the chlorhexedine mouth rinse. [livestrong.com]

• Pain

  You can also decrease the inflammation and pain of gingivitis while helping your body fight the infection. [livestrong.com]

  NSAIDs and topical xylocaine for pain relief are also prescribed for patients with chronic gingivitis and ANUG. [symptoma.com]

  Swollen, painful, red or peeling gums and the presence of any ulcers or abscesses is noted, as is the amount of plaque and tartar present. [news-medical.net]

  Salt water may also: soothe inflamed gums help ease pain reduce bacteria remove particles of food relieve bad breath To use a salt water rinse: Add 1/2 to 3/4 teaspoon of salt to a glass of lukewarm water and mix well. [healthline.com]

• Swelling

  Gingivitis - Frequently asked questions 5 Gingivitis remedies suggested by our users gum swelling suggested by liz on Sunday, January 27, 2008 Baking soda or soda bicarb for gum swelling suggested by rehana on Friday, January 4, 2008 peroxide suggested [home-remedies-for-you.com]

  CASE REPORT: This paper reports a 16 year old male with a complaint of bleeding and swelling of gingiva since 3 years. The gingival enlargement occurred on facial aspect of upper and lower anterior teeth involving attached gingival. [ncbi.nlm.nih.gov]

  Other symptoms can include tenderness, redness and swelling of the gums. Gingivitis occurs when plaque builds up on your teeth. Plaque is usually removed by brushing, but if it builds up it can irritate your gums and may cause bleeding and swelling. [healthdirect.gov.au]

  Signs & Symptoms 1) Redness and swelling of gums 2) Bleeding gums on brushing or flossing 3) Unpleasant taste 4) Bad breath 5) Toothache 6) Small gum abscesses If you have painful gums with swelling and bleeding, you should immediately get in touch with [medium.com]

  Retrieved from https://www.yourdictionary.com/Gingivitis gingivitis noun Inflammation of the gums, characterized by redness and swelling. [yourdictionary.com]

• Fever

  These work by stopping your body from making a substance that causes pain, fever, and inflammation. NSAIDS may cause some side effects, such as constipation, diarrhea, intestinal gas, ulcers, lightheadedness, nervousness or ringing in the ears. [livestrong.com]

  In rare cases, fever and sepsis following the destruction of the soft tissue are observed in the patients with gingivitis. In such patients, intravenous antibiotics therapy is initiated. The dentist must stress on the importance of oral care. [symptoma.com]

  […] more severe than those of gum disease and can include: bleeding, painful gums painful ulcers receding gums in between your teeth bad breath a metallic taste in your mouth excess saliva in your mouth difficulty swallowing or talking a high temperature (fever [nhs.uk]

  This is usually carried out when the fever or swelling is serious. Treatment Since this disease is a condition which clears up without treatment, typically within 5 to 7 days; therefore no treatment is needed. [hip-knee.com]

• Overeating

  Other common over-the-counter NSAIDs include aspirin, naproxen and ketoprofen. [livestrong.com]

  When bacterial toxins accumulate over time (as happens when plaque is not removed) the body mounts a response by producing enzymes. Toxins and enzymes dissolve bone and surrounding tissue holding the teeth. [singhealth.com.sg]

  RESULTS: Each treatment group showed a significant increase of the ICDAS index, but not of the GI over the course of time with no significant intergroup differences detectable. [ncbi.nlm.nih.gov]

  Try Our Treatment Tips Today When you combine usage of over-the-counter, anti-gingivitis products with regular cleanings at the dentist, you’ll be doing what it best for your gums. [positivehealthwellness.com]

• Nausea

  Metronidazole and amoxicillin may also cause the following side effects: nausea (feeling sick) vomiting diarrhoea Painkillers Paracetamol and ibuprofen are the most commonly prescribed painkillers. They are also available over-the-counter (OTC). [hse.ie]

  If pregnant women are neglecting oral hygiene because of morning sickness and/or fatigue, dentists can suggest ways to keep the teeth and gums clean without making the nausea worse. [msdmanuals.com]

• Vomiting

  Brush your teeth twice per day, especially after vomiting from morning sickness. Practice good nutrition. Your gums usually return to normal following the delivery of your baby. The bleeding and sensitivity should diminish as well. [americanpregnancy.org]

  Frequent vomiting, for example, can expose your teeth to stomach acid. That can erode your enamel or promote the formation of cavities. [batchelor-dentistry.com]

  Metronidazole and amoxicillin may also cause the following side effects: nausea (feeling sick) vomiting diarrhoea Painkillers Paracetamol and ibuprofen are the most commonly prescribed painkillers. They are also available over-the-counter (OTC). [hse.ie]

  Other side effects of metronidazole and amoxicillin can include feeling sick, vomiting and diarrhoea. Painkillers Paracetamol and ibuprofen are the most commonly prescribed painkillers. They're also available over the counter from pharmacies. [nhs.uk]

• Periodontitis

  (Gingivitis and periodontitis are two distinct stages of gum disease.) What's the difference between gingivitis and periodontitis? Gingivitis usually comes before periodontitis. [my.clevelandclinic.org]

  The sooner you seek care, the better your chances of reversing damage from gingivitis and preventing its progression to periodontitis. [mayoclinic.org]

  Periodontal probing may also be used to test for periodontitis. The probe is a long, thin stick that is inserted beside the tooth under the gum line, with the tip placed in the gum pocket. [news-medical.net]

  The link between periodontal disease and general health The effects of periodontal disease are not limited to the mouth. [singhealth.com.sg]

• Tooth Loss

  Tooth decay (dental caries) also may result. If not treated, gingivitis can advance to periodontitis and eventual tooth loss. Risk factors Gingivitis is common, and anyone can develop it. [mayoclinic.org]

  […] and potential tooth loss. [yourdentistryguide.com]

  If your gingivitis is not treated, it can spread to underlying bone, which is a condition called periodontitis that can lead to tooth loss. [livestrong.com]

• Bleeding Gums

  PUBLISHED: PUBLISHED: 11:01, Sat, Jun 3, 2017 GETTY Bleeding gums: It's not always gum disease Gum disease is a common condition where the gums become swollen, sore of infected. Symptoms include - famously - bleeding gums, and bad breath. [express.co.uk]

  RECOGNIZE THE SYMPTOMS Red, swollen gums are an indication that gingivitis is present. Other symptoms include bleeding gums and a noticeable change in the color of your gums (pink to red). [dovedentalcentres.com]

  […] on the gums or insides of cheeks What to do if you have painful or bleeding gums Don’t be tempted to assume that your gums are bleeding because you brushed a little too hard. [dentaly.org]

  Healthy gums are pale pink in colour, firm, and they never bleed. Gum inflammation is relatively common. The main symptoms are red, swollen and bleeding gums. [schwabingzahnarzt.de]

  What Do Bleeding Gums Mean Bleeding gums are caused by inadequate plaque removal. Plaque contains germs which attack the healthy tissue around the teeth. [bleedinggums.com]

• Poor Oral Hygiene

  While poor oral hygiene is usually the cause of gingivitis, there are a number of other factors that can contribute as well, including: Smoking Diabetes Certain medications Substance abuse Pregnancy Genetics Stress Poor nutrition Puberty Certain diseases [yourdentistryguide.com]

  Trench mouth is rare today in developed nations, though it's common in developing countries that have poor nutrition and poor living conditions. Prevention Good oral hygiene. [mayoclinic.org]

  Gingivitis is usually caused by poor oral hygiene. Remove plaque every day by brushing and flossing because it re-forms quickly, usually within 24 hours. [livestrong.com]

• Halitosis

  Halitosis (bad breath) Halitosis is the medical name for bad breath. The most common cause of bad breath is tiny food particles trapped in your teeth and mouth. [healthdirect.gov.au]

  VSCs emit indole, skatole, and polyamines, which results in halitosis. [therabreath.com]

  Halitosis ( bad breath ), in which the breath begins to take on a foul odor, may be present in more severe forms of gingivitis. When Should Someone Seek Medical Care for Gingivitis? For simple gingivitis, work with a dentist. [emedicinehealth.com]

• Erythema

  Abstract Desquamative gingivitis is a condition characterized by intense erythema, ulceration, and desquamation of the free and attached gingiva. [ncbi.nlm.nih.gov]

  (acute) gingivitis) 괴사성 궤양성 (급성) 치은구내염(Necrotizing ulcerative (acute) gingivostomatitis) 스피로헤타성 구내염(Spirochaetal stomatitis) 참호 구강염(Trench mouth) 뱅상 구협염(Vincent's angina) 뱅상 치은염(Vincent's gingivitis) A69.2 라임병(Lyme disease) 보렐리아 부르그도르페리에 의한 만성유주성 홍반(Erythema [dic.impact.pe.kr]

  Epulis Pyogenic granuloma Congenital epulis Gingival enlargement Gingival cyst of the adult Gingival cyst of the newborn Gingivitis Desquamative Granulomatous Plasma cell Hereditary gingival fibromatosis Hypercementosis Hypocementosis Linear gingival erythema [en.wikipedia.org]

• Flushing

  Never flush floss down the toilet. When choosing oral health care products, check for the Canadian Dental Association (CDA) Seal of Recognition. [cda-adc.ca]

  When people have pericoronitis, dentists may flush salt water under the flap of gum to rinse out the debris and bacteria. Sometimes, people are instructed to rinse at home with salt water, hydrogen peroxide, or the antiseptic chlorhexidine. [msdmanuals.com]

  Oral irrigators flood the mouth with a jet of water under pressure to flush offending food particles and bacteria from the mouth. They can remove any debris leftover after brushing. [wikihow.com]

• Petechiae

  Petechiae and ecchymoses may appear throughout the mouth. In pellagra, the gingivae are inflamed, bleed easily, and are susceptible to secondary infection. [merckmanuals.com]

• Chancre

  Open syphilis sores or chancres provide an easy entry and exit for HIV and can increase viral load Antibiotic coverage and periodic medical check ups will be the line of treatment Analingus, cunnilingus and fellatio Chlamydia STD caused by the Chlamydia [ncbi.nlm.nih.gov]

• Withdrawn

  […] of Tocilizumab in Combination With MTX in the Evolution of Articular Damage (Synovitis/Osteitis and Erosions) Evaluated by MRI in the Hand of Patients With Moderate to Severe Rheumatoid Arthritis (RA) and Inadequate Response to Non-biological DMARDs Withdrawn [malacards.org]

  When compound delivery was complete, the needle was left in place for 5 min and then withdrawn such that it took approximately 1 min to fully withdraw the needle. [doi.org]

• Seizure

  For example, calcium channel blockers and seizure medications cause the gums to grow excess tissue. Any medication causing dry mouth will effect the gums too. [laserdentistbaltimore.com]

  Certain prescription drugs — including anti-seizure medications, cyclosporin (Neoral, Sandimmune) and calcium channel blockers — can cause gum overgrowth and inflammation. Symptoms You will notice red, swollen, gums that bleed easily. [colgateprofessional.com]

  […] deficiency Dental restorations that don't fit properly or crooked teeth that are difficult to clean Conditions that decrease immunity such as leukemia, HIV/AIDS or cancer treatment Certain drugs, such as phenytoin (Dilantin, Phenytek) for epileptic seizures [mayoclinic.org]

Laboratory testing does not help to diagnose gingivitis. However, if a systemic disease or toxin is suspected, laboratory tests are recommended. Generally, imaging studies are not indicated in patients with gingivitis [6].

• Candida

  Thrush (candidiasis) is a fungal infection in which the overgrowth of fungi, particularly Candida albicans, forms a white or red patch that irritates the gums. [msdmanuals.com]

  Examples of diseases or infections that cause mucosal irritation include: Herpes Mononucleosis Gonorrhea Strep Candida (fungal) AIDS Leukemia HIV Gingivitis can be localized or generalized, depending on the location. [trustedhealthproducts.com]

  In addition to lubricating mucosal surfaces; saliva dilutes the microbial burden and flushes microorganisms into the gastrointestinal tract for inactivation and destruction.[22] Dentinal carious lesions may serve as a reservoir for Candida organisms in [ncbi.nlm.nih.gov]

• Capnocytophaga

  The genera Porphyromonas, Treponema, and Tannerella showed higher relative abundance in the subjects with gingivitis, while the genera Capnocytophaga showed higher proportions in health controls. [ncbi.nlm.nih.gov]

  Bacteria involved in the etiology of gingivitis include specific species of Streptoccous, Fusobacterium, Aclinomyces, VeiUonella, and Treponema and possibly Bacteroides, Capnocytophaga, and Eikenella. [onlinelibrary.wiley.com]

  Phylogenetic tree based on 16S rRNA gene comparisons showing the relationship between Capnocytophaga _HS5_2W_I24 and members of the genus Capnocytophaga. [doi.org]

Intervention from emergency department (ED) is generally not called for in patients with chronic gingivitis. Pain management is the requirement for patients with ANUG in the ED. In rare cases, fever and sepsis following the destruction of the soft tissue are observed in the patients with gingivitis. In such patients, intravenous antibiotics therapy is initiated.

The dentist must stress on the importance of oral care. The dentists remove the plaque, and calculus to avoid progression of the disease. He may advise to clean the mouth with warm saline water. Use of fluoride dentifrice, electric toothbrush and regular flossing will slow the progression of the disease. Some studies have concluded that brushing followed by rinsing with chlorhexidine also yield good results.

Some of the medications used in the management of gingivitis are non-steroidal anti-inflammatory drugs (such as ibuprofen, acetaminophen with codeine), local anesthetics and antibiotics. Antibiotics eradicate the bacterial infections in the patients with ANUG. NSAIDs and topical xylocaine for pain relief are also prescribed for patients with chronic gingivitis and ANUG. Penicillin V, erythromycin, minocycline (used as an adjunct to scaling), doxycycline, and clindamycin are some of the common antibiotics that are used to manage ANUG. Chlorhexidine has bactericidal activity and is helpful in combating the progression of the disease. Topical anesthetics such as lidocaine can help in controlling the pain and allows the patient to brush and floss without trauma [7] [8] [9].

If gingivitis is not treated, it can lead to tooth loss; however, with initial cleaning and scaling, gingivitis can be reverse and the patients respond well with appropriate treatment. Management of patients with ANUG requires the aggressive treatment with antibiotics. Patient with intact host defenses often respond well to treatment.

Inadequate oral hygiene is the primary cause of the chronic gingivitis. Other risk factors of this disease are smoking, use of tobacco, alcohol, patients with compromised immune system (diabetes, HIV/AIDS), and periodontitis. Diabetes mellitus, blood dyscrasias, inadequate removal of plaque, allergic reactions, poor nutrition, and lack of dental examination increases the chance of gingivitis several fold.

Gingivitis can also be caused by some drugs such as anticoagulants, fibrinolytic agents, oral contraceptives, phenytoin, danazol, vitamin A and its analogues, calcium channel blockers and protease inhibitors. Acute necrotizing ulcerative gingivitis (ANUG) is a complication of chronic gingivitis with poor or abandoned hygiene and weak host defenses. ANUG is not contagious and is caused as a result of invasion by ubiquitous organisms of the soft tissue [2].

In developed countries such as Australia, Sweden, Switzerland and England 48 to 85% of the children (ages between 3 and 6 years) have reported gingivitis. Among adolescents, the incidence of gingivitis across the world range between 50% and 90%. ANUG is common in regions which face poor living conditions. Gingivitis can cause health-issues in the patients. In some studies, the periodontal disease may be one of the factors of coronary artery disease or ischemic stroke.

The elevated levels of the markers of the chronic inflammation (C-reactive protein) fall after the treatment of the periodontal disease. Chronic gingivitis may lead to tooth loss. In patients with type-2 diabetes, gingivitis can be managed well by improved glycemic control. During pregnancy, periodontal disease is often associated with preterm birth and adverse pregnancy outcomes. Gingivitis is relatively more prevalent in males than females [3] [4] [5].

Accumulation of the microbial plaque due to inadequate oral hygiene, leads to the development of gingivitis. The initial stages of gingivitis (which begins within 4 or 5 days of formation of plaque) manifest as lesions which later progresses to advanced disease. With time, gingival fluid and increase of migration of neutrophils to the site is seen. In the initial stage itself, there is a deposition of fluid and the destruction of the collagen.

After 1 week, the infiltration of lymphocytes to the site occurs. With time, the lesions become chronic and are often characterized by the presence of the B lymphocytes and plasma cells. Bleeding during brushing or even chewing is also observed. Persistent inflammation leads to the breakdown and destruction of the local alveolar bone, loosening the teeth.

ANUG, on the other hand, is caused by the acute infection of the gingiva with Actinomyces species, alpha-hemolytic streptococci or Prevotella intermedia. ANUG leads to accelerated destruction of the affected tissues [1] [2].

Gingivitis and ANUG can be prevented by having a good oral hygiene, and regular dental check-up.

Inflammation which is limited to the mucosal epithelial tissues and which surrounds the cervical portion of the teeth and the alveolar processes is referred to as gingivitis. Depending on the clinical appearance, etiology and duration, gingivitis is classified. The most common chronic gingivitis is caused by plaque. [1]

Definition

Gingivitis is the inflammation of the gums due to bacteria which is present in the deposition of plaque buildup. Irritation and gum bleeding is common in patients with gingivitis.

Cause

Gingivitis is caused due to poor oral hygiene. Other risk factors of gingivitis are smoking, alcohol and diseases such as diabetes and HIV/AIDS (which impairs the immune system). Some medications such as anticoagulants, fibrinolytic agents, phenytoin and oral contraceptives can also contribute to the progression of gingivitis.

Symptoms

Symptoms of gingivitis are gum-bleeding, pain and swelling of the gums. 

Diagnosis

Diagnosis of gingivitis can be done by observing the oral cavity by a dentist. If the systemic disease is suspected, laboratory tests are recommended.

Treatment

Treatment of gingivitis involves use of painkillers such as ibuprofen and local anesthetics (lidocaine). The patient must also be advised about the advantages of having proper oral hygiene to combat the bacteria. 

1. Robinson PJ. Gingivitis: a prelude to periodontitis? J Clin Dent. 1995;6 Spec No:41-5. 
2. Prasad D, Kunnaiah R. Punica granatum: A review on its potential role in treating periodontal disease. J Indian Soc Periodontol. 2014 Jul;18(4):428-32.
3. 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.
4. Lockhart PB, Bolger AF, Papapanou PN, et al. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?: A Scientific Statement From the American Heart Association. Circulation. Apr 18 2012
5. Mealey BL. Periodontal disease and diabetes: A two-way street. J Am Dent Assoc. Oct 2006;137 Suppl 2:26S-31S.
6. Ranney RR. Diagnosis of periodontal diseases. Adv Dent Res. Dec 1991;5:21-36
7. 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. 
8. 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.
9. 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.
10. Haas AN, Pannuti CM, Andrade AK, et al. Mouthwashes for the control of supragingival biofilm and gingivitis in orthodontic patients: evidence-based recommendations for clinicians. Braz Oral Res. 2014 Jul 11;28(spe):1-8.