16.1.1 Gingivitis
Inflammatory changes in the gingival develop within a couple of days of undisturbed bacterial growth on the gingival margin of the erupted tooth in the oral cavity
Diagnostic Criteria:
- Gingival redness
- Swollen and shiny gingival tissue
- Increased tendency of the gingival to bleed on gentle probing or spontaneously, during tooth brushing or even on touch and on biting bread and fruits
- Bad breath from the mouth
Prevention and non-pharmacological Treatment
- Counsel to perform proper oral hygiene care
- Remove accumulated plaque and teach oral hygiene on systematic tooth brushing and other adjuvant means of oral hygiene (dental flossing, tongue cleaning on the dorsal part, use of mouth washes including saline mouth wash)
16.1.2 Periodontitis
This is the progression of the inflammation of gingival into the deep tissue affecting the periodontal membrane causing periodontal pockets, introduction of infection and destruction of periodontium. The damage of the periodontal membrane, periodontal ligaments and eventually alveolar bone leads to formation of pockets which eventually favours more pathogenic bacterial growth. As the destruction continues the teeth become loose and may eventually fall out.
Diagnostic Criteria
- Reddened, swollen gingiva
- Easily bleeding gingival on gently probing
- Periodontal pocket
- Loose/mobile teeth
- Bad breath from the mouth
- Gingival recession
Investigation: Mainly X-ray (orthopantomogram (OPG)) to determine extent of bone loss
Non-pharmacological Treatment
- Instruct and guide the patients on proper oral hygiene for proper plaque control
- Plaque control should be undertaken by the dentists by scaling and root planning (this may need several visits as may be necessary)
- Advanced treatment is required– if refractory/resistant to treatment or patient has systemic diseases/ conditions.
Pharmacological Treatment
Mouth wash: Do not swallow
A: Hydrogen peroxide 3% 6 hourly for at least for 5 days
OR
A: Chlorhexidine gluconate 0.2% 12 hourly at least for 5 days
OR
Use antibiotics only for refractory and severe cases as well as those with evidence of periodontal abscess formation:
A: Metronidazole (PO) 400mg 8 hourly for 8 days
AND EITHER
A: Amoxicillin (PO) 500 mg 8 hourly for 8 days
OR
A: Doxycycline (PO) 100mg 12 hourly for 10 days
Note: Patients with systemic diseases/conditions such as diabetes mellitus, liver and renal diseases, HIV/AIDS, and those who are pregnant or heavy smokers of cigarette are generally at increased risk of periodontal diseases and their management may need referral to a periodontal specialist.
16.1.3 Acute Necrotizing Ulcerative Gingivitis (ANUG)
It is a severe form of gingivitis and i s characterized by rapid destruction of gingival tissue, particularly in the area of the interdental papilla. Patients usually present with soreness and bleeding of the gums and foul smell test (fetor-ex ore/halitosis). Acute Necrotizing Ulcerative Gingivitis (ANUG) is also called Vincent’s gingivitis or Vincent’s gingivostomatitis. It is common in malnourished children and immunocompromised individuals especially patients with diabetes and HIV/AIDS.
Diagnostic Criteria
- Painful and easily bleeding gingival swelling and erythema of the gingival margins
- Yellowish-white ulceration of the gingival
- Fever, malaise and regional lymphadenitis
- In some patients (especially malnourished children), ANUG may presents with extensive destruction of the face and jaws in the severe form known as Cancrum Oris or noma
Pharmacological treatment
Professional cleaning with Hydrogen Peroxide 3% (under local anesthesia)
A: Metronidazole 400 mg (PO) 8 hourly for 5 days
AND
A: Amoxicillin 500mg (PO) 8 hourly for 5 days
16.1.4 Stomatitis
This is generalized inflammation of the oral mucosal (including the gingiva) due to different aetiologies such as infections, chemical burn, radiation and allergy.
Diagnostic Criteria
- Oral sores and ulceration
Pharmacological treatment
Generally supportive
Mouth wash
A: Hydrogen peroxide solution 3% 6 houlry for at least 5 days
OR
C: Chlorhexidine 0.2% topical oral gel 12 hourly
Note: Mouth wash should not be used at the same time with the gel. Also should not be swallowed.
Oral analgesics can be added
A: Paracetamol (PO) 1gm 8 hourly for at least 3 days
OR
A: Ibuprofen (PO) 400 mg 8 hourly for at least 3 days
OR
C: Diclofenac (PO) 50 mg 8 hourly for at least 3 days
