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Gingivitis and periodontitis are two forms of inflammatory periodontal diseases that impact the health of the supporting structures around teeth.
There are a few key differences between the diseases that will be discussed below, but overall, gingivitis is identified as the earliest form of periodontal disease as a response to the presence of biofilm and plaque deposits on the teeth, which harbor harmful bacteria.
Keep reading to learn more!
As discussed in a previous post, Periodontitis: The Basics, periodontitis is a non-curable inflammatory disease that causes irreversible destruction to supporting structures around teeth.
However, periodontitis is considered an end-stage disease, so what
comes before that? Gingivitis.
Gingivitis occurs as the initial inflammatory response to pathogenic bacteria that live within dental biofilm and plaque. If not removed with proper home care routines (such as brushing, flossing, water flossing, tongue scraping, etc.), the biofilm and plaque are able to mature and become increasingly harmful to oral tissues.
With gingivitis, the inflammatory response impacts only the soft tissues around the teeth, or the gums, and is a reversible condition. Comparatively, with periodontitis, the inflammatory response has gone on long enough to begin causing irreversible destruction of more supporting structures such as the bone that holds teeth in place.
[3]
Gingivitis and periodontitis have similar clinical presentations. So, how
do we distinguish between the two?
Both gingivitis and periodontitis present clinically with similar symptoms [5]
Reddish or purplish gum tissue
Bleeding & swelling of gum tissue
Shiny gum tissue
Tenderness of gum tissue
[2]
Chronic gingivitis is thought to affect 50–90% of the adult population, and it can be present in children [1].
Differential Diagnosis
Differential diagnosis is typically made by assessing a comprehensive periodontal chart, including probing depths, recession, furcation involvement, and mobility, and assessment of dental radiographs.
Comprehensive Periodontal Chart
A comprehensive periodontal chart for a patient with gingivitis will typically have 4mm probing depths with generalized moderate to severe bleeding.
There will likely be no furcation involvement, which requires bone loss and is thus considered periodontitis.
Some teeth may have mobility, but it is typically caused by occlusal trauma in patients with gingivitis.
A comprehensive periodontal chart for a patient with periodontitis will have probing depths 5mm or greater in localized or generalized areas of the mouth.
Areas of active periodontitis will have bleeding on probing (BOP).
If a patient has stabilized periodontitis, there should be limited to no BOP.
Important note: patients who smoke tobacco products often don't have BOP due to the constriction of blood vessels associated with their smoking habit. This can cause a missed diagnosis of periodontal disease if proper medical history isn't obtained.
Dental Radiographs
When diagnosing periodontal disease, dental radiographs are used to assess the level of health of the bone surrounding teeth.
In gingivitis cases, there will be no changes to bone visible on the radiographs.
In periodontitis, there will be noticeable changes to bone density and bone height around some or all teeth
The greater the amount of changes seen with bone density and height, the worse the prognosis is for long-term health and maintenance of the impacted teeth.
[2]
The true distinguishing factor that separates gingivitis and periodontitis is based on the presence of damage to the structures that support the teeth, mainly the surrounding bone.
[4]
Similar to periodontitis, the causes and risk factors of gingivitis are multifactorial.
Gingivitis etiology [6]
Poor oral hygiene
Systemic conditions
Nutrient deficiencies
Certain medications
Misaligned teeth
Ill-contoured dental restorations
Ill-fitting or unclean mouth appliances
Xerostomia (dry mouth)
Tobacco use, including vaping
The most common cause of gingivitis is poor oral hygiene,
which is known as plaque-induced gingivitis [6].
Types of gingivitis [6]
Plaque-induced gingivitis
If biofilm and plaque are not regularly removed, they harden and form calculus, which harbors pathogenic bacteria
Nutritional gingivitis
May occur due to a deficiency of Vitamin C
Modern lifestyle with increased amounts of refined carbohydrates promotes inflammation
Hormonal gingivitis
Puberty Gingivitis
Hormonal alterations influence how the gingival tissues react to biofilm and plaque accumulation
Pregnancy Gingivitis
Hormonal alterations and predisposition to dilating blood vessels
Drug-induced gingivitis
Various drugs used for systemic conditions can cause gingival side effects such as gingivitis and/or gingival enlargement (i.e. hyperplasia)
Epileptic seizure medications
Calcium channel blockers (treat hypertension)
Anticoagulants (blood thinners)
Oral contraceptives
Necrotizing ulcerative gingivitis (NUG)
Aggressive gingivitis with ulcers of the gingival tissues but no changes to underlying bone support
Acute Necrotizing Ulcerative Gingivitis (ANUG)
Sudden onset of NUG associated with high levels of stress and poor home care
[5]
The treatment goal of gingival therapy (i.e. the treatment of gingivitis) is to reduce inflammation via the removal of dental biofilm and plaque deposits by a trained dental professional with ongoing improvements of home care habits by the patient.
Important note: although gingivitis is reversible, it is also a recurrent disease. Without active participation by patients in their oral health routines, disease is likely to return and may advance to irreversible stages of periodontitis requiring more involved and expensive treatment.
Top recommended home care habits for oral health
Electric toothbrush 2-3x/day
Tongue scraper 1x/day
Expanding floss 1x/day
Use of a water flosser 1x/day
Oral probiotics 1-2x/day - based on individual need
Avoid regular use of antibacterial mouthwash
If you’re not sure what products would be best for you, talk with your dental healthcare professional for individualized recommendations.
For a list of my favorite products, check out my Resources page here!
Check back soon to read part two of this series on periodontal disease where we will take a deeper dive into the specific pathogens associated with this chronic disease & their impact on all systems of the body.
Talk soon,
Liz Laney, BSDH, RDH
Oral-Systemic RDH & Educator
Have questions about periodontal disease or want to know more?
Check out the forum and start a conversation!
Sources
Chronic gingivitis. Pocket Dentistry. January 4, 2015. https://pocketdentistry.com/3-chronic-gingivitis/.
Disease entities and diagnosis. Pocket Dentistry. January 17, 2015. https://pocketdentistry.com/disease-entities-and-diagnosis/.
Gingivitis. Mount Sinai Health System. https://www.mountsinai.org/health-library/diseases-conditions/gingivitis.
King S, Chow CK, Eberhard J. Oral Health and cardiometabolic disease: Understanding the relationship. Internal Medicine Journal. 2022;52(2):198-205. doi:10.1111/imj.15685
Martos J, Von Ahn Pinto K, Feijo Miguelis TM, Cavalcanti MC, Cesar Neto JB. Clinical treatment of necrotizing ulcerative gingivitis: a case report with 10-year follow-up. General Dentistry. Published online March 26, 2018:62-65. doi:10.26226/morressier.5ac383262afeeb00097a43dd
Rathee M, Jain P. Gingivitis. StatPearls. StatPearls Publishing. Updated 2023 Mar 27. https://wwwncbi.nlm.nih.gov/books/NBK557422/
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