Generally, gingivitis is most commonly caused by a bacterial infection of the gingival tissue. Some clinical observations of this bacterial infection include swelling, tenderness, redness and bleeding upon probing. As gingivitis is generally painless and doesn't spontaneously bleed, patients consequently fail to seek dental attention on time. As such, further worsening of the disease becomes inevitable in the case of poor dental hygiene. It is important to differentiate gingivitis with periodontitis, as gingivitis does not cause tooth loss. Gingivitis, however, does increase the risk of and could easily develop into periodontitis. It is, therefore, crucial to manage gingivitis as a preventative measure.
As its name suggests, plaque-induced gingivitis is caused by a thin layer of plaque which forms on the surface of the tooth (localized to the gingival sulcus). This microbial plaque continues to accumulate and harden into calculus (yellow-ish color) if not regularly removed. Due to this plaque accumulation, a bacterial inflammation could occur in the gingival tissue. Consequently, an immune response is triggered which can lead to the destruction of gingival tissue. Naturally, the form of the teeth (such as overcrowding and misaligned teeth) could encumber plaque removal or require dental correction beforehand.
The development of gingivitis can be categorized into three stages, namely the initial lesion, early lesion and established lesion. The initial lesion is visible after two to four days after the formation of calculus. The first lesion appears after an inflammation as a response to the activation of leukocytes (white blood cells) and the stimulation of endothelial cells (inner cellular lining of blood vessels). This stage of the development of gingivitis is in general not clinically visible.
The second stage of the development of gingivitis is the early lesion. The early lesion is visible after four to seven days after the formation of calculus. If still left untreated, the immune response intensifies, the gingival tissue comes under more pressure (leading to a loss of 10-15% of gingival connective tissue) and an increased extracellular collagen loss of up to 70% occurs. At this stage, some of the clinical visible symptoms are swelling and increased redness.
The third and final stage of the development of gingivitis is the established lesion (chronic clinical adult gingivitis). The established lesion is visible after two to three weeks after the formation of calculus. If still not treated or not effectively cleared up by T-cells, a more aggressive immune response is triggered and a decrease of T-cells occurs. Leading to more destruction of the gingival connective tissue and a greater loss of extracellular collagen. At this stage a significant production of plasma cells and, consequently, an increase of antibodies can be detected at the inflammation zone. Some of the clinical visible symptoms include a change in gingival colour (blue-ish), size and texture.
In conclusion, plaque-induced gingivitis is the most common periodontal disease. This gum disease is a consequence of a lack in dental hygiene which leads to a build up of microbial plaque. Consequently, a bacterial inflammation occurs which triggers the immune system. If left untreated, the immune response intensifies and the destruction of the gingival connective tissue increases. Thus, increasing the risk of periodontitis. However, if the plaque accumulation is regularly removed through daily dental care and dental visits, the effects of gingivitis could be properly managed.
References:
Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol. 2018 Jun;89 Suppl 1:S46-S73. [PubMed]
Murakami S, Mealey BL, Mariotti A, Chapple ILC. Dental plaque-induced gingival conditions. J Clin Periodontol. 2018 Jun;45 Suppl 20:S17-S27. doi: 10.1111/jcpe.12937. PMID: 29926503.
Leonardo, T., Roberto, F., Cleverson O., S., & Dimitris N., T. (2018) Plaque-induced gingivitis: Case definition and diagnostic considerations, Journal of clinical periodontology, 89.SUPnan: S44-S67.
Iain L. C., C., Brian L., M., Thomas E. Van, D., P. Mark, B., Henrik, D., Peter, E., Maria L., G., Robert J., G., Michael, G., Moshe, G., Terrence J., G., Palle, H., Georgia K., J., Yvonne, K., Niklaus P., L., Joerg, M., Shinya, M., Jacqueline, P., Giuseppe A., R., Lior, S., Dimitris N., T., Wim, T., Leonardo, T., Clemens, W., Gernot, W., Pinelopi, X., & Hiromasa, Y. (2018) Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, Journal of Periodontology, 89.SUPnan: S68-S77. Assessed and Endorsed by the MedReport Medical Review Board
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