Diagnosis and Treatment Plan for Gingival Diseases and Conditions

*Anahita Punj and Manav Chaturvedi*

#### **Abstract**

The prevalence of gingival and periodontal disease is manifold and has not been highlighted much due to its asymptomatic and milder symptoms. It is usually given its due importance when the gingival disease progresses to advanced periodontal disease, displays symptoms of dull pain and tooth mobility, and is associated with pus discharge. The starting point of periodontal disease is usually gingival disease which is a reversible condition. It is therefore necessary to diagnose gingival diseases at an early stage to prevent its progression to irreversible periodontal disease. The diagnosis of gingival disease becomes cumbersome due to its similarity in the presentation of signs and symptoms. Gingival diseases can occur due to microbial attack from the plaque biofilm which is usually bacterial in nature. There are other viral, fungal, and immune-mediated mechanisms which can result in gingival diseases. Some systemic conditions also influence the gingiva which allows for diagnosing systemic diseases and treating these conditions appropriately. It is said that oral cavity is the mirror of the body, and in that sense the gingiva is the biggest surface where any changes or manifestations could be observed.

**Keywords:** gingivitis, gingival disease, diagnosis, treatment

#### **1. Introduction**

The gingiva or commonly referred to as gums surround and protect the teeth (**Figure 1**). Gingival diseases by namesake denote to the diseases affecting the gingival tissues. These diseases have burdened the human race since the early civilization, and this is proof enough to gauge the importance of diagnosing gingival diseases and treating them. Gingival disease if left untreated can progress to periodontal tissues and result in periodontal disease which is easier to diagnose probably due to its chronic and severe nature as compared to gingival disease. No wonder periodontal disease has been mentioned in the literature of ancient Egypt and a step toward preventing it by means of oral hygiene practices deserves its mention in the ancient scriptures [1].

#### **2. Gingival disease terminology**

The gingival disease terminology and classification has undergone many changes, and the current classification given at the World Workshop in 2017

**2.1 Diagnosis of plaque-induced gingivitis**

*DOI: http://dx.doi.org/10.5772/intechopen.91726*

*Diagnosis and Treatment Plan for Gingival Diseases and Conditions*

**Factor Effect on gingiva Signs and**

Microbial attack mounts a host response in the form of inflammation

Potential modifying factors of plaque-induced gingivitis

Exaggerate the host inflammatory response in the presence of minimal

Exaggerates the host inflammatory response in the presence of minimal

plaque

plaque

summarized in **Table 2**.

Systemic conditions

Sex steroid hormones (estrogen and progesterone) (1) Puberty

(2) Menstrual cycle

**33**

Bacterial dental biofilm only

Gingivitis per se refers to the inflammation of the gingival tissues and is labeled with different diagnostic terms based on the etiology and clinical presentation to aid in formulation of the best-suited treatment. As mentioned above, the broad etiologic factors which result in gingival disease is the dental biofilm, which contain microbes, causing a microbial attack on the gingiva resulting in a dysbiosis amounting to a host response manifested in the form of the inflammatory disease called plaque-induced gingivitis. The plaque microbes have an influence on the gingiva depending upon its quantity and quality of pathogens present. Although the increased plaque burden is almost always associated with gingivitis, there are instances where paucity of plaque can again result in gingivitis due to the effect of modifying factors which make the host response more accentuated and exaggerated as they tend to have a more systemic affect than a local one [2, 4]. These modifying factors include few systemic conditions, factors which increase plaque accumulation and influence of drugs on gingiva. How these factors can affect gingivitis is

> **symptoms for diagnosis**

Mild redness with or without broken line of bleeding

Mild changes in color and texture of the gingiva

Glazing redness, edema, enlargement, bleeding on probing

Bleeding on probing or bleeding with toothbrushing, mild to moderate redness

Mild redness, edema based on severity of inflammation seen during the menstrual cycle

**Diagnosis Treatment [5]**

Incipient gingivitis OHI

Mild gingivitis OHI +/OP

Moderate gingivitis OHI + OP

Severe gingivitis

OHI + OP

Overt redness and edema and bleeding on palpation rather on

Diagnostic term not given as not seen frequently in population and if present can be diagnosed as gingivitis associated with puberty

Diagnostic term not given as not seen frequently in population and if present can be diagnosed as gingivitis

probing

#### **Figure 1.**

*The diagnosis of any disease is based on a proper documentation of case history which requires precise identification of signs and symptoms of disease and also any underlying medical disease/condition which may influence the same. The next step is to correlate clinical, pathological, laboratory and radiological findings. This sequence of steps also holds true for gingival diseases. This chapter attempts to focus on the minute differences in the diagnosis of gingival diseases which becomes cumbersome due to a simple fact that any infection or inflammation usually results in swelling up of the gingiva, bleeding, or formation of ulcers or vesicles. Such symptoms could be due to a single to multiple etiologic agents corresponding to varied diagnoses and treatment regimens [2].*

classifies gingival condition in health and disease under three broad categories of health, dental biofilm-induced gingivitis, and non-dental biofilm-induced gingival disease [3] (**Table 1**).


**Table 1.** *Classification of periodontal health, gingival disease, and condition [3].*
