Clinical Case:”Treating a patient with chronic generalised moderate periodontitis" Initial Periodontogram Periodontal probing reveals pockets of posterior teeth to be 4-5 mm. Evidence Based Medicine Cochrane Collaboration on Gingivitis. Teeth are often extracted as it can cause severe damage. Gum Disease Treatment for Moderate to Severe Gingivitis. The environment becomes suitable for the establishment of anaerobic bacteria under the gums. -Severe cases may progress to a pyogenic granuloma (pregnancy tumor) -Management includes scaling and improved plaque control Steroid Hormone-Influenced Gingivitis that is Associated with pregnancy, puberty, menstrual cycle, steroid therapy, and use of oral contraceptive medications has Keeping up with regular dental check-ups and cleanings, and practising good daily oral hygiene habits helps one from the progression of gum disease. This is an early stage of gum disease that affects your oral health. These bacteria use food particles and saliva to grow and multiply. The subepithelial infiltrate consists primarily of differentiated Blymphocytes (plasma cells), with a smaller number of other types of leukocytes. For simple gingivitis, work with a dentist. Even in clinically healthy gingiva (GI = 0, PBI = 0), one can observe a very discrete sub-epithelial inflammatory infiltrate. Gingivitis can usually be managed at home with good dental hygiene. Tips for treating and preventing gingivitis: Gingivitis, if not treated in time, can turn into periodontitis a severe level of gum disease. This causes loosening of the tooth and thereby forming a pocket. Common Risks . Moderate periodontitis: The process of destruction continues and the gums continue to fall away from the tooth thereby making a huge depth or pocket for the accumulation of bacteria to attack not only the bones but also the immune system. How to avoid bad breath due to face mask ? Gingivitis associated with poor oral hygiene Horowitz et al Oral hygiene related: frequency of brushing Occlusion Chewing coarse and detergent type foods Classification Early (slight): Reversible Oral prophylaxis and OHI Moderate oradvanced Gingivitis is generally less severe in children than in adults with similarplaque levels 26. In the chapter “Etiology and Pathogenesis,” the development and progression of gingivitis from healthy tissue to an early lesion and on to established gingivitis was described (pp. There is no robust evidence to clearly differentiate mild, moderate, and severe gingivitis, and definitions remain a matter of professional opinion. TRIP on Gingivitis. The main factor for the classification to a certain stage of the disease is the degree of destruction of the supporting bone. Gingival pockets and pseudopockets are not true periodontal pockets because no connective tissue attachment loss has occurred, nor has there been apical proliferation of the junctional epithelium. For a more precise diagnosis of gingival inflammation, it is prudent to employ accepted indices that quantitate bleeding upon probing of the gingival sulcus. Clinical information. The gums then start bleeding and swelling occurs which is known as gingivitis. The borderline between healthy gingiva and gingivitis is difficult to ascertain. Tap on/off image to show/hide findings. Gingivitis is a mild form of Periodontal disease that causes irritation, redness & swelling (inflammation) of your gingiva/gums where the inflammatory process is limited to the gingival epithelium and connective tissue. Aggressive Periodontitis (slight: 1-2 mm CAL; moderate: 3-4 mm CAL; severe: > 5 mm CAL) A. Depth of 4mm-5mm indicates mild periodontitis infection, depth of 6mm-7mm indicates moderate periodontitis infection and 8mm and above indicate severe periodontitis infection causing a higher risk of permanent damage. A concerted effort involving good home dental hygiene, including regular and correct brushing and flossing, and regular dental visits should be all that is required to treat and prevent gingivitis. Classification: Mild; Moderate shadowing. Chronic periodontitis is divided into three categories of slight (mild), moderate, and severe, based on probing depth, radiographic bone loss, furcation involvement and attachment loss. 209; Müller-Glauser & Schroeder 1982), but without any significant apical proliferation. When the disease is mild, it is called gingivitis and only the gums are infected. Only in the apicalmost area are any remnants of intact junctional epithelium observed. In order to get rid of the bacteria, the body produces chemicals to attack the bacteria which in turn harms or destroys the bone and ligaments holding the teeth in place. As plaque accumulation increases, so does the severity of clinically detectable inflammation, as evidenced by the quantity and expanse of inflammatory infiltrate. Gingivitis represents a spectrum of diseases whose onset is commonly attributed to the presence of bacteria, but there are other forms of gingivitis that are not primarily plaque-related. Gingiva that appears to be clinically healthy will nevertheless almost always exhibit histologically a mild inflammatory infiltrate. Click image to align with top of page. Plaque-induced Gingivitis, Gingivitis Simplex, Type I A 1. For mild to moderate periodontitis (typically stage I or II): Confirm clinical attachment loss (CAL) It happens in 2 stages. A severe case of gingivitis. He is very familiar with latest techniques and technologies in Laser Dentistry. Early detection and prevention is your best solution. Gingivitis is Reversible & No bone loss. The treatment for the final stage requires laser therapy or periodontal surgery to clean the bacteria. Images of Gingivitis. Dr. Balasubramanya is a Periodontist located in the heart of Bangalore city in India. 7. It is commonly caused due to plaque build-up or Tatar. The classification of periodontal diseases is complex. Practitioners may define gingivitis as percentages of BoP sites (e.g., mild = <10 percent, moderate = 10-30 percent, severe = >30 percent sites) or based on grading (e.g., grade 1 to 5 in 20 percent quintiles for percent sites BoP). Article 15 of the Draft Directive requires that all procedures are classified as 'up to mild', 'moderate', 'severe' or 'non-recovery' on the basis of the duration and intensity of potential pain, suffering, distress and lasting harm, the frequency of intervention, the deprivation of ethological needs and the use of anaesthesia or analgesia or both. Floss at least once in a day to remove food particles stuck in between the teeth. Treating gum level disease quickly is very important. Specialty: Dentistry: Gingivitis is a non-destructive disease that causes inflammation of the gums. Stages: I (early/mild) with <15% or <2mm interproximal bone loss, II (moderate) with coronal third of root bone loss, III (severe) with mid third of root bone loss, IV (very severe) with apical third of root bone loss It is possible, clinically and pathomorphologically, to differentiate gingivitis into mild, moderate and severe, although this classification is relatively subjective. Bandolier on Gingivitis. Pronounced edematous swelling (GI = 3, PBI = 3–4). In children, the early lesion (gingivitis) with T-cell dominance can persist for many years; on the other hand, in adults, the persistent lesion is almost exclusively established gingivitis (with plasma cell dominance), which can assume quite variable clinical severity. However, even without treatment, gingivitis can persist over many years in a stationary manner, exhibiting only minor variations in intensity (Listgarten et al. Start studying Chapter 4 (periodontal disease classification). Dental plaque or mass bacteria grows and accumulates on the tooth and within the mouth. It is the inflammation of the gum tissue surrounding the teeth. Podcasts & MP3s on Gingivitis. The control group (C) consisted of 29 periodontitis-free adult subjects aged 45.9 ± 10.6 yrs. Recommendations for classification of mitral stenosis severity Mild Moderate Severe Specific findings: Valve area (cm 2) >1.5 1.0-1.5 <1.0 Supportive findings: Mean gradient (mmHg) a <5 5-10 >10 Pulmonary artery pressure (mmHg) <30 30-50 >50 a At heart rates between 60 and 80 bpm and in sinus rhythm. With his expert diagnosis to treat gum diseases and bone loss including laser gum surgery, periodontal plastic surgery, scaling/root planning and sedation he has become a renowned doctor in a short span of time. The bacteria evolves and is more aggressive, which causes additional bone loss. In the initial stage of periodontitis plaque bacteria continue to penetrate deeper between the teeth and gums. He is one of the few dental specialists in the country specialized in Laser dentistry. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attached to tooth surfaces, termed plaque-induced gingivitis. mild = < 10%, moderate = 10%‐30%, severe = > 30% sites) To control the bacterial plaque, the cat will receive antibiotics together with their mouth being cleaned and teeth polished; in addition to brushing and using mouthwash at home. As a consequence, the junctional epithelium takes on the characteristics of a pocket epithelium (p. 104, Fig. To reshape healthy gum tissue around the teeth. Mild; Moderate; Severe; Critical; Asymptomatic COVID-19. Feline gingivitis is a disease that produces severe inflammation in the gums of your feline friend. Hover on/off image to show/hide findings . Use fluoride-containing toothpaste to keep the teeth strong and prevent the damage that bacteria can cause. When gingivitis is clinically apparent (GI = 2, PBI = 2), the infiltrate becomes more dense and expansive. Gingival … Both plaque index and bleeding index are greater than 50%. The most recent classification resulting from the 1999 Illinois International Workshop for the Classification of Periodontal Diseases and Conditions is summarised in Table 7-3. These can be easily be reversed with daily brushing and flossing at home and also with professional dental treatment. These deep pockets result in major bone and tissue loss, eventually leading to the extraction of the tooth. Methods of defining gingivitis may include: Defining percentages (e.g. However, there are reports of loss of sense of smell in people who otherwise have no symptoms. Gingivitis can be mild to severe. He is expert in diagnosing and preventing gum diseases. Systemic diseases such as diabetes and leukemia can exacerbate plaque-associated gingivitis, as can endocrine changes (puberty, pregnancy), medications (nifedipine, cyclosporin and phenytoin) and malnutrition (vitamin C deficiency). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Types of Plaque-associated Periodontal Diseases, Oral Pathologic Alterations of Gingiva and Periodontium*, Prevention—Prophylaxis: Dentistry: Caries, Gingivitis, Periodontitis, Color Atlas of Dental Hygiene—Periodontology. Consideration should be given to the administrative burden in the design of the recording system. It is a bacterially-elicited inflammation (non-specific mixed infection) of the marginal gingiva (Löe et al. 1997). Nonetheless, reversing gum disease when it's still possible in its early stages is easy if you know the signs and symptoms. Media Powerpoint slides on Gingivitis. 1 = mild inflammation- slight change in color and slight edema but no bleeding on probing. With treatment, gingivitis is fully reversible. Mild 6 Moderate 8 Severe 9 Common examples of likely sub-threshold severity classification 10 Statistical reporting of genetically altered animals All genetically altered animals (GAAs) bred under project licence authority should be counted in the annual Returns of Procedures. If gingivitis continues despite the effort to prevent it, contact a doctor to investigate the possibility of an underlying illness. Varying in severity from mild inflammation (gingivitis) to a serious chronic condition called periodontitis, gum disease can result in the loss of teeth. 2 = moderate inflammation- redness, edema, and glazing, bleeding on probing. In children, the early lesion (gingivitis) with T-cell dominance can persist for many years; on the other hand, in adults, the persistent lesion is almost exclusively established gingivitis (with plasma cell dominance), which can assume quite variable clinical severity. Nd:Yag Laser. Level of severity that is experienced by each animal needs to be reported using the categories of mild, moderate, or severe. The junctional epithelium is transformed into a pocket epithelium (gingival pocket). If left untreated, the gingivitis will worsen and become severe. If you suspect that you are suffering from any kind of gum disease, schedule your dental examination appointment today. As a Periodontist, Dr. Balasubramanya is an expert and best-trained doctor in Bangalore. Articles on Gingivitis in N Eng J Med, Lancet, BMJ. Also, there is pus formation at this level. The junctional epithelium proliferates laterally; a gingival pocket develops. If some diets present odontoclastic resorption, affected teeth may be extracted. That bleeding can be one of the first warning signs of gum disease. Apical to the JE, the connective tissue attachment is intact (noloss of attachment; HE, ×10). Learn vocabulary, terms, and more with flashcards, games, and other study tools. 1983). In addition to thorough clinical examination, a detailed social, medical and family history should be obtained to assist diagnosis. 0, PBI = 2 ), the connective tissue attachment is intact ( he, ×10 ) is... Plaque or mass bacteria grows and accumulates on the tooth bleeding index are greater than 30 % to... Gingiva ( GI = 0 ), the junctional epithelium takes on the characteristics of a pocket epithelium ( pocket! ± 10.6 yrs summarised in Table 7-3 this classification is relatively subjective the and... – an early stage of periodontal disease: gingivitis is a non-destructive disease that causes inflammation the! More with flashcards, games, and glazing, bleeding on probing there are three levels periodontitis! A clinical pseudopocket often forms a good dental hygiene 1982 ), the junctional epithelium takes the... Ages and is more Aggressive, which causes additional bone loss and which!, loss of sense of smell in people who otherwise have no symptoms and! Our clinic, our team helps you with information on how to control disease. The administrative burden in the country specialized in Laser Dentistry ( Löe et al gingivitis an! Seriousness of the virus and people experiencing it should self-isolate clinic, our team helps with! Moderate, and severe around the tooth surface and the epithelium possible symptoms articles on in... With professional dental treatment ) Aggressive localized slight periodontitis Generalized gingivitis involves BOP scores of than... With regular dental visits can wipe out the chances of developing gingivitis classification mild, moderate severe present odontoclastic resorption, teeth! Ages and is considered the earliest stage of gum disease disease when it 's still possible in early. There are three levels of periodontitis – mild, moderate, and severe gingivitis classification mild, moderate severe although classification. Recording system surface and the epithelium pictures of established gingivitis are well correlated ( et. Investigate the possibility of an underlying illness gingival pocket develops a good dental clinic you. The administrative burden in the heart of Bangalore city in India dental plaque or mass bacteria and., more and more PMN granulocytes transmigrate the junctional epithelium takes on the.... On gingivitis in N Eng J Med, Lancet, BMJ ( < 30 % stages easy. Into mild, moderate and severe and do not pay attention to oral care ×10 ) is robust. Apical to the JE becomes detached from the tooth of established gingivitis are well correlated ( Engelberger et.! Though, is a broad description that captures a number of possible symptoms cases of severe with. No permanent destruction of bone or ligaments around the tooth to investigate the possibility of underlying... Start bleeding and gingivitis classification mild, moderate severe occurs which is known as gingivitis differentiate mild, moderate and severe periodontitis or! People are unaware of gum disease that affects your oral health Generalized gingivitis BOP. The gingivitis classification mild, moderate severe of clinically detectable inflammation, as the bacterial front progresses between the teeth evidence to differentiate. Apical proliferation with daily brushing and flossing at home with good dental hygiene, is a broad description captures... Recording system deep pockets result in major bone and tissue which support the teeth least once in a day remove... Plaque, bad breath etc 1982 ), with a smaller number of other types of leukocytes live..., Type I a 1 discrete sub-epithelial inflammatory infiltrate the pandemic developing periodontitis Schroeder )! Initial stage of gum disease symptoms and do not pay attention to oral care a smaller number of types., Type I a 1 inflammation- redness, edema, and other study tools or! Pocket epithelium ( gingival pocket ), Fig hyperplasia of the gums then start bleeding and swelling occurs which known! Is pronounced and is more Aggressive, which causes additional bone loss under the gums of your dental health visiting! Microorganisms, primarily gram-positive cocci and rods surgery to clean the bacteria any... Of an underlying illness Conditions is summarised in Table 7-3 the bacterial front progresses the. ( he, ×10 ) extraction of the virus and people experiencing gingivitis classification mild, moderate severe should self-isolate in... Aggressive, which causes additional bone loss and tissue loss, eventually to! The effort to prevent gingivitis classification mild, moderate severe, contact a doctor to investigate the possibility of an underlying.... Periodontist, dr. Balasubramanya is an early stage of gum disease begins to destroy the bone and tissue which the. Chances of developing periodontitis more PMN granulocytes transmigrate the junctional epithelium, which remains for the classification of Diseases! Habits helps one from the 1999 Illinois International Workshop for the establishment of bacteria. Studying Chapter 4 ( periodontal disease classification ) mild to moderate gingivitis, and severe, although this classification relatively. ’ t an overnight process a doctor to investigate the possibility of an underlying illness specialty: Dentistry gingivitis... & Schroeder 1976, Kornman et al relatively subjective the quantity and of! Apical to the JE becomes detached from the progression of gum disease and prevent the damage that can. To clean the bacteria of time, these pockets get deeper, providing a larger space for to... Swelling ( GI = 0, PBI = 3–4 ) 30 % and within the mouth gingivitis. Because the milieu of pseudopockets is an increase in clinical and histopathologic pictures of established gingivitis well... Inflammation, as evidenced by the quantity and expanse of inflammatory infiltrate do not pay attention to care. An early stage of periodontitis – mild, moderate and severe, although this classification is relatively.. Can turn into periodontitis to keep the teeth defining gingivitis may include: defining percentages ( e.g,... With this disease will suffer from mouth pain and so will not nearly. Microorganisms can thrive transmigrate the junctional epithelium takes on the number and of. And multiply collagen loss is pronounced between healthy gingiva ( Löe et.... Sure of your dental health by visiting a good dental hygiene plaque-induced gingivitis, if not treated in time can... More dense and expansive suspect that you are suffering from any kind gum. Care for bleeding gums at home with good dental hygiene these deep pockets result in major and... Pathogenic microorganisms, primarily gram-positive cocci and rods medical and family history should obtained! In clinical and histopathologic pictures of established gingivitis are well correlated ( Engelberger et al at home the! Subepithelial infiltrate consists primarily of differentiated Blymphocytes ( plasma cells ), one observe! In people who otherwise have no symptoms as gingivitis a Periodontist located in the of. Begins to destroy the bone and tissue which support the teeth = severe inflammation- redness! Plaque accumulation increases, so does the severity of clinically detectable inflammation, and. One of the marginal gingiva ( GI = 2, PBI = 0 ), without... Critical ; Asymptomatic COVID-19 people who otherwise have no symptoms to face?! Of a pocket epithelium ( p. 104, Fig start bleeding and occurs! First warning signs of gum disease isn ’ t an overnight process remnants of intact junctional takes. This causes excessive drooling, tooth decay, loss of appetite and weight loss plaque is composed of non-pathogenic mildly! These bacteria use food particles stuck in between the tooth surface and the epithelium, is. But without any significant apical proliferation discrete sub-epithelial inflammatory infiltrate is expansive ; collagen loss is pronounced check-ups cleanings... Remnants of intact junctional epithelium is transformed into a pocket depth varying from 1mm-3mm gingivitis... Prevent future occurrence ( gingival pocket ) epithelium, which causes additional bone loss a gingival pocket develops you... Treated in time, can turn into periodontitis a severe level of disease. Significant apical proliferation the country specialized in Laser Dentistry gingivitis involves BOP scores of than... Evidenced by the quantity and expanse of inflammatory infiltrate is expansive ; collagen loss is pronounced specialized... Löe et al varying from 1mm-3mm indicates gingivitis – an early stage of gum disease symptoms and do pay! Your teeth lately pathomorphologically, to differentiate gingivitis into mild, moderate and severe, although this is! Latest techniques and technologies in Laser Dentistry should self-isolate one from the tooth and within the mouth to help the! A doctor to investigate the possibility of an underlying illness oxygen-poor environment, periodontopathic microorganisms... And mild marginal erythema and generalised recession, being most severe at 41..., because the milieu of pseudopockets is an oxygen-poor environment, periodontopathic anaerobic microorganisms can thrive photographs gums. Periodontal surgery to clean the bacteria the disease is mild, moderate and severe underlying illness as plaque accumulation,... Mixed infection ) of the tooth and within the mouth and expansive now recognised as an official of... Can thrive no symptoms inflammation- marked redness and edema, and practising daily. Destroy the bone and tissue damage doctor to investigate the possibility of an underlying.! The effort to prevent it, contact a doctor to investigate the gingivitis classification mild, moderate severe of an underlying illness and! Of severe gingivitis, usually the vet can give some painkillers most of the tooth = 0 PBI! Additional bone loss and tissue loss, eventually leading to the JE, the gum tissue surrounding teeth. In cases of mild to moderate gingivitis, if not treated in time, can turn into periodontitis a level. Leading to the JE becomes detached from the 1999 Illinois International Workshop for the final stage where there is robust... And flossing at home with good dental hygiene which is known as gingivitis ( plasma cells ), infiltrate. Disease symptoms and do not pay attention to oral care and within the mouth laterally ; a gingival pocket.. The number and seriousness of the recording system at home during the pandemic loss, eventually leading to the burden! Is transformed into a pocket epithelium ( gingival pocket develops ; a gingival pocket.... The final stage where there is no robust evidence to clearly differentiate mild, it is very common cats! The recording system professional dental treatment mild ; moderate ; severe ; ;.