The clinical appearance may range from a barely perceptible increase in redness, puffiness, or swelling of the gingival tissues (gums) to severely inflamed reddened and swollen gingiva. A common clinical symptom reported by patients is transient bleeding during tooth brushing and use of various mechanical means of cleaning between the teeth, such as dental floss and tooth picks. Gingivitis is accompanied by the accumulation of bacterial plaque (biofilm) on the teeth, but because dental plaque is white and translucent, it is not visible on the teeth unless there is very heavy accumulation. Gingivitis may also be characterised by the presence of calculus, and other plaque-retentive factors (e.g., dental fillings with open and/or overhanging margins, poorly fitting partial dentures, over-contoured crowns, cervical caries). There is no radiographic evidence of loss of the adjacent supporting bone. Purulent exudates (pus) can occasionally be seen at sites with gingivitis, although it is most often detected at sites with chronic periodontitis. Halitosis is a common finding in gingivitis.
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