Gingival inflammation is caused by bacterial plaque (dental biofilm) that accumulates daily on the teeth.
Results in redness, slight swelling, or "puffiness" of the gums and bleeding on tooth brushing.
Treatment involves thorough professional tooth cleaning and effective daily removal of dental plaque by tooth brushing and cleaning between the teeth.
Necrotising gingivitis is a more serious condition that is mainly found in developing countries and is associated with people with severe malnutrition or people living with HIV with low CD4 counts.
Gingivitis is inflammation of the gingiva. The vast majority of cases are related to bacteria-induced inflammation caused by the dental plaque (bacterial biofilm) that forms daily on the teeth. Necrotising gingivitis is an atypical, acute form of bacteria-related gingivitis that is rarely found in developed countries. This topic focuses on these two forms of gingivitis.
Many other potentially serious conditions (congenital or acquired, and a number of genetic syndromes) may feature inflammation or lesions of the gingiva and these must always be considered within the differential diagnosis.
History and exam
Key diagnostic factors
- presence of risk factors
- bleeding on tooth brushing
- dental plaque
- necrosis and ulcers in free gingiva
Other diagnostic factors
- redness, swelling, and puffy gingiva
- pseudomembrane formation
- cervical lymphadenopathy
- poor oral hygiene
- diabetes mellitus
- severe malnutrition or marginal nutritional deficiencies
- HIV/AIDS (in necrotising gingivitis)
- stress (in necrotising gingivitis)
- severe (viral) infections (in necrotising gingivitis)
- previous history of necrotising gingivitis
- stress (in plaque-induced gingivitis)
- xerostomic medicines
- male sex
- extreme living conditions (necrotising gingivitis)
- high alcohol intake
- substance abuse
1st investigations to order
- clinical diagnosis
necrotising gingivitis (NG)
- Oral lichen planus
- Nursing management of oral hygiene
Stopping smokingMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer