What's the harm in a little gingivitis?

Everyone has gingivitis, right? While not true, some of your patients may think so. Many of our patients may see a little 'pink' when they spit after brushing caused by bleeding, but fail to mention this and think it is normal. They may not be aware that biofilm causes gingivitis and that this is an acute inflammation that, if it is left for the long term untreated, can progress to the soft tissue and bone loss of periodontitis. Patients often do not report any issues because there are few signs they notice that signals gingivitis; they are not in pain or they think that a little bleeding is normal.

Biofilm-induced gingivitis signals poor oral care. Signs of gingivitis include:

1. Gingival swelling and loss of intact dental papillae
2. Redness (erythema) of the gingivae
3. Bleeding gums, usually occurring on probing but bleeding can also be spontaneous

A clinical examination will reveal these signs at regular dental assessments. During their visits, we should educate our patients on oral hygiene and the signs of gingivitis. Fortunately, if caught early, gingivitis is reversible and preventable with good oral regimes. Professional care may also be necessary to treat gingivitis. Women who are pregnant frequently experience pregnancy gingivitis, which can also be prevented and treated. Some patients are also at increased risk for periodontal disease (including gingivitis) and those who are more at risk should be flagged when reviewing their medical and social history. For example, patients who have a family history of periodontal disease, smokers, and certain medical conditions such as diabetes. We must educate our patients that this condition is inflammatory in nature and can progress into irreversible periodontitis if left untreated and that this can lead to pain, tooth mobility and tooth loss, and that periodontitis is also linked with other systemic conditions such as diabetes, arthritis and cardiac disease.

All of this makes diagnosing and treating gingivitis essential once it is present. And, what can we advise our patients to do in order to prevent the ‘pink in the sink?’

1. For patients who already have gingivitis, a visit for scaling may be necessary, prophylaxis is performed and oral hygiene advice for home care must be given. Patients can also be prescribed a 0.12% chlorhexidine gluconate rinse, such as Colgate PerioGard which is also alcohol-free. This rinse helps in the treatment of gingivitis and promotes healing of inflamed gingival tissue. Patients should have another appointment to check on their response.

2. For ongoing home care, brushing with an antibacterial toothpaste twice a day should be recommended, for example Colgate Total Toothpaste which is anti-plaque/anti-gingivitis. Patients should also be advised on interdental cleaning once a day, for example with dental floss.

3. Oral rinsing with an antimicrobial mouth rinse such as Colgate Total Pro-Shield, which contains cetylpyridinum chloride (CPC), offers protection against plaque and gingivitis when used after brushing..

4. All patients should receive regular dental visits for examination, oral health advice and prophylaxis. Treatment might also be required depending on the severity of the gingivitis and the patient's individual risk factors.

The importance of diagnosing and treating gingivitis is evidenced by its inclusion in the 2017 American Academy of Periodontology classification of Periodontal and Implant diseases, therefore all dental professionals must stress the importance of preventing and treating gingivitis in our patients.