Gingivitis, chronic periodontitis

What is Gingivitis and what is it caused by ?

Inflammation of the gingiva (gum) (doesn’t affect support for teeth)

Mostly caused by bacteria build up in dental plaque forming calculus

Is gingivitis reversible 

Yes, can be removed with good dental hygiene 

doesn’t affect support for teeth

Usually mild

Gingivitis signs and symptoms 

• Inflammation of gum

• Swollen, red and sore gums

• Bleeds easily on mild trauma - bleeding with brushing, flossing or eating hard food

• Plaque visibility 

• No fever, or malaise ( no systemic symptoms)

What additional questions should you ask for gingivitis?

• Confirm symptoms : are consistent with gingivitis, no systemic symptoms 

• Is there bleeding with or without trauma (without trauma refer)

• Ask about toothbrushing techniques/ oral hygiene 

• Any medication they are taking e.g warfarins, NSAIDS (increase bleeding) or phenytoin 

Red flags ( when you need to refer)

• White patches

•  persistent ulcers

• numbness 

• Spontaneous bleeding

• Certain medications

• Lumps in the neck

• Does not improve with good oral hygiene

What factors increase the risk of gingivitis/periodontitis

• Poor nutrition 

• Ineffective oral hygiene 

• Pregnancy 

• Diabetes

• Smoking 

• Immunocompromised 

• Age 

• Drugs causing dry mouth 

• Stress

• Local factors

How do you manage gingivitis

• Advise regular review with dentist or dental hygienist 

• Identify risk factors and manage (e.g smoking, diet)

• Advice on oral hygiene 

• Daily interdental cleaning before brushing 

• Mouthwash not routinely recommended unless signs of inflammation 

What advice should you give on oral hygiene (8)

• brush your teeth twice a day ( morning and night) using a fluoride containing toothpaste

• Use an electric toothbrush

• When brushing don’t rinse, just spit out

• Replace your toothbrush frequently every 1-3 months or when it needs to be changed

• Clean in between your teeth using floss or interdental brushes

• Toothbrush small head and medium size bristles

• Don’t apply too much pressure when brushing your teeth

• Bleeding is common whilst brushing don’t stop

When is mouthwash recommended + how should you use it

When there are signs of inflammation

A different time of day to when you’re brushing your teeth

Chlorhexidine gluconate mouthwash

• what are different brand names

• What is the dosage

• What side effects can come

• How do you use it

• corsodyl or eludril

• 10ml twice a day, not at the same time of brushing

• Stains teeth and tongue brown with prolonged use but can be removed by dental hygienists

• Swish around the mouth for a minute, spit don’t rinse

Hexetidine mouthwash

• brand names

• What is the dosage

• How to use it

• Oraldene

  Dosage: 15ml 3 times a day

  How to use : swish around the mouth for a minute, spit don’t rinse 

What is chronic periodontitis and what is caused by it 

Chronic inflammation of the gum including supporting tissues around the teeth 

Formation of pockets 

Tissue and bone damage, tooth loosens 

Largely irreversible, slowly progressive

Chronic periodontitis signs and symptoms 

• halitosis (bad breath), foul taste in mouth, difficulty eating, pain 

• Gum recession or root sensitivity ( sharp pain when eating hot or cold things)

• Loosening or drifting of teeth 

• Sign of infection- abscess/puss