Diagnosis | Gingivitis: Gum Inflammation

Diagnosis

Before the treatment of a possible gingivitis a comprehensive screening must be carried out. This screening includes both the assessment of the current tooth status and the evaluation of the periodontium. This means that, in addition to documenting the condition of the tooth substance, the appearance of the gums is also precisely assessed.

For this purpose the dentist measures the depth of possible gum pockets. The measurement can basically be done in two different ways: In addition, the preparation of an X-ray image (orthopanthomogram; short: OPG) can be useful for patients with severe disease patterns. The OPG provides a complete image of the teeth, jawbone and joints in the jaw.

The dentist uses it as an aid in assessing the condition of the bone structures involved. The orthopantomogram is the only way to determine how far the inflammatory processes have spread and how much damage they have already caused.

  • Periodontal screening index (short: PSI) is measured on each tooth and is divided into different degrees of severity by codes 0-4.

    To assess the depth of the gum pockets, a blunt probe is inserted by the treating dentist between the tooth substance and the gum. This is usually painless for the patient and also completely harmless for the function of the gums. If at this point the presence of gingivitis is suspected, a special microbial test can be carried out during the preliminary examinations to determine the exact germ count.

  • Gingival bleeding index (GBI) is an index that does not provide information about the gum pockets, but it does provide information about the general condition of the gums. The dentist inserts a blunt probe along the gum line and observes if there is bleeding.

Types of gingivitis

Simple gingivitis is caused by bacterial plaque. It shows itself in a superficial redness and swelling of the gum line and can bleed easily when touched, for example when brushing the teeth. There is no influence on bone resorption and no tooth loosening.

The inflammation is not painful and is therefore often misjudged. The treatment consists of removing the plaque and can possibly be supported by rinsing with anti-inflammatory drugs. After removing the causative factors, this form of gingivitis heals quickly.

If left untreated, however, it can develop into a disease of the periodontium. Gingivitis gravidarum is a form of gingivitis that can occur during pregnancy. This form is not caused by bacterial plaque, it is hormonal.

Unlike “normal” gingivitis, the removal of plaque does not bring any improvement. The bleeding tendency of the reddened and swollen gums is greater than in simple gingivitis. Due to the swelling, pseudo-pockets are formed in which plaque can easily accumulate.

After the birth of the child, this gingivitis also disappears again due to the change in the hormonal balance. This form of gingivitis can also be caused by hormones. It can occur in women during the menopause.

In most cases, however, it is the manifestation of another disease. For this reason, it is necessary to cooperate with doctors from other specialties, especially dermatologists. In this form of gingivitis, the connective tissue of the gums is altered and the surface can be easily detached.

The gums are strongly reddened, smooth and shiny, they are painful and bleed easily.The entire gum is not changed, but can be limited to some areas. Dental treatment consists of pain treatment and avoiding additional infection by careful oral hygiene. It is important to identify the underlying physical disease and its treatment.

This is an inflammation of the gums, which is accompanied by ulcers. It begins at the gum papilla in the interdental space and then spreads to the gum line. The consequences are defects of the tissue.

The ulcers can also spread to the oral mucosa. If treated with antibiotics in time, healing can occur, otherwise defects in the interdental space and an infestation of the periodontium remain. The predominant symptom of this form of gingivitis is bleeding from the gum tissue.

It starts in the interdental space and then continues to the rest of the gums. As the gums continue to decay, the teeth become loose and finally they are lost. This clinical picture is observed in scurvy, i.e. the lack of vitamin C, and therefore occurs only very rarely today, since a vitamin C deficiency practically does not occur with today’s diet.

It is a proliferation of the papillae in the interdental space, which can cover the whole tooth, occurring mainly in the anterior region. It is not an inflammatory product, but rather a congenital one. The growths are benign and can be removed surgically.

However, a recurrence is very likely. Similar growths are also possible with chronic use of antiepileptic drugs. The therapy consists of discontinuing the medication or, if this is not possible, also surgical removal.

Toxic gingivitis/gingivitis is based on heavy metal poisoning with lead or mercury. A bluish to black seam forms along the gums. It is suspected that these are sulfur compounds.

The concentration of mercury that may be released from amalgam fillings is far from sufficient to cause this clinical picture. Rather, the dangers lie with workers involved in the mining or processing of heavy metals. In the case of leukemia (a form of cancer that affects the blood-forming system), swelling and inflammation of the gums can occur. The treatment depends of course on the underlying disease.