Gingivitis

Disease Description (Causes and Symptoms)

• Definition: Gingivitis is localized inflammation of the gums (gingiva), mainly caused by bacterial plaque on the tooth surfaces. When calcified dental calculus is present, continuous bacterial irritation worsens the inflammation. Hormonal changes (puberty, pregnancy, etc.) affect gingival blood vessels and immune responses, promoting the development of gingivitis.
• Pathophysiology: The interaction between pathogenic bacteria in plaque accumulated on the tooth surfaces and the host immune response (of the oral mucosa and gingiva) causes dilation of gingival blood vessels, swelling, and bleeding. If left untreated, the inflammation may spread to the gingival connective tissue, periodontal ligament, and alveolar bone, progressing to periodontitis.
• Main symptoms: Gingival redness, swelling, bleeding when brushing, halitosis (bad breath), and gingival tenderness or discomfort. In the early stages, subjective symptoms are often mild.
• Epidemiology (reference): The prevalence of gum disease is high among adults (e.g., more than 50% in those aged 20 and older and approximately 75% in those aged 35 and older), and it is more frequent in older adults. Approximately half of pregnant women may experience pregnancy gingivitis.

Treatment Methods

• Basic principles: The removal of plaque and dental calculus and improvement of oral hygiene are essential. Most cases can recover with early diagnosis and management.
• Nonsurgical treatment
  • Professional scaling (calculus removal) and tooth polishing: Helps improve inflammation by removing plaque and dental calculus.
  • Education on proper toothbrushing (at least twice a day, using a soft-bristled brush; the Bass or roll technique is recommended) and daily use of dental floss and interdental brushes.
  • Short-term use of a topical mouthwash (e.g., 0.12% chlorhexidine mouthwash) may help control inflammation, but caution is needed regarding side effects with long-term use, such as tooth-surface staining.
• Medication treatment
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used as needed to control pain and inflammation.
  • In cases of systemic signs of infection (fever, swelling, purulent discharge, etc.) or acute periodontal abscesses, antibiotics (e.g., amoxicillin, metronidazole, etc.) may be considered. Avoid indiscriminate antibiotic use and follow the doctor's prescription.
• Surgical treatment
  • Generally unnecessary at the gingivitis stage. In cases of chronic or advanced periodontal tissue loss (periodontitis), periodontal surgery (such as periodontal flap surgery or regenerative surgery) may be considered.
• Lifestyle management and precautions
  • Smoking cessation: Smoking impairs the healing of inflammation and promotes disease progression.
  • Strengthen oral hygiene management during hormonal changes (pregnancy, puberty, use of oral contraceptives, etc.). Scaling during pregnancy is generally safe (especially recommended during the second trimester), but consult a doctor and dentist before treatment.
  • Regular dental checkups (usually every 6 months, or more frequently if necessary) and regular scaling are recommended.
• Prognosis: With proper oral hygiene and dental treatment, the condition is reversible and recoverable in most cases. If left untreated, there is a risk of progression to periodontitis and tooth loss.

Points to Check Before an Outpatient Visit (Including Example Questions)

• Items to prepare and information to confirm
  • List of medications currently being taken (including anticoagulants, immunosuppressants, hormone medications, etc.)
  • Previous dental treatment records (recent scaling, prosthetic treatment, extractions, etc.)
  • When symptoms began and how they have changed (frequency of bleeding, presence of pain, pus or swelling, fever, etc.)
  • Smoking status and alcohol consumption and oral care habits
  • Whether you are pregnant or may be pregnant (gestational age)
  • Recent systemic diseases (diabetes, cardiovascular disease, etc.) and medical records
  • Photos of the affected area, if possible, or a symptom diary
• Information that can be provided at the outpatient visit
  • Providing recent dental examination records, if available, and dental radiographs taken within the past 1–2 years is recommended.

Examples of General Questions to Ask the Doctor

• "What treatment is needed for a complete recovery from this condition, and how long is it expected to take?"
• "What are the side effects and duration of use for the prescribed medications, such as mouthwash and pain relievers?"
• "How often should I have regular checkups and scaling?"
• "What oral care methods should I pay particular attention to in daily life?"

Examples of Condition-Specific Questions

• If pregnant: "When and how can I safely receive treatment for gingivitis during pregnancy, such as scaling?"
• If the patient smokes: "How much does smoking cessation affect gum healing, and are additional measures needed to help quit smoking?"