Chronic gingivitis, also known as marginal gingivitis or simple gingivitis, primarily affects the free gingiva and gingival papillae, making it the most common type of gingival disease. This condition occurs worldwide across all races, and nearly everyone experiences it to some degree or extent in their lifetime.

bubble_chart Etiology

The long-term accumulation of dental plaque on the tooth surface near the gingival margin is the initiating factor for chronic marginal gingivitis. Other factors such as dental calculus, food impaction, and poorly fitted restorations can promote plaque accumulation, triggering or exacerbating gingival inflammation.

bubble_chart Diagnosis

1. Location and extent of the lesion: The lesion of chronic marginal gingivitis is generally confined to the free gingiva and gingival papilla, and in severe cases, it may also involve the attached gingiva, usually most prominent in the anterior teeth area, especially the mandibular anterior teeth area.

2. Manifestations of the lesion

1. Gingival color: Normal gingiva is pink. In marginal gingivitis, the free gingiva and gingival papilla become dark red or deep red due to vascular congestion and hyperplasia in the gingival connective tissue.
2. Gingival contour: In gingivitis, due to tissue edema, the gingival margin thickens and no longer adheres closely to the tooth surface. The gingival papilla becomes rounded and hypertrophic. When the attached gingiva is edematous, the stippling may disappear, and the surface appears smooth and shiny.
3. Texture: In gingivitis, due to connective tissue edema and collagen destruction, the gingiva may become soft and fragile, lacking elasticity.
4. Gingival sulcus depth: In healthy periodontal tissue, the gingival sulcus depth generally does not exceed 2mm. When the gingiva is inflamed or hyperplastic, the sulcus may deepen to more than 2mm, forming a false periodontal pocket.
5. Bleeding on probing: Healthy gingiva does not bleed during brushing or probing of the gingival sulcus. In gingivitis, slight contact may cause bleeding, and probing also induces bleeding. Bleeding after probing is an important objective indicator for diagnosing gingival inflammation.
6. Increased gingival crevicular fluid: In gingival inflammation, the exudation of gingival crevicular fluid increases, with a significant rise in leukocytes. Some patients may also experience purulent discharge from the sulcus. Therefore, measuring gingival crevicular fluid can serve as an indicator of inflammation severity.
7. Subjective symptoms: Patients with chronic marginal gingivitis often experience bleeding during brushing or biting hard objects, or notice blood stains on food, which is the main reason for seeking treatment. However, chronic marginal gingivitis usually does not cause spontaneous bleeding, distinguishing it from gingival bleeding caused by blood disorders or other diseases. Some patients may occasionally feel localized itching, swelling, or discomfort in the gingiva, along with fetid mouth odor.

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bubble_chart Treatment Measures

1. Remove disease causes: Through scaling, thoroughly eliminate dental plaque and calculus. If there are irritating factors such as food impaction or poor restorations, they should also be completely corrected. Since simple gingival margin inflammation does not involve deep periodontal tissue damage, as long as the local irritants are removed, the color, shape, and texture of the gums can return to normal.
2. Medication: If the inflammation is severe, local medication can be used in conjunction. Commonly, 1-3% hydrogen peroxide solution is used to rinse the gingival sulcus, and iodine preparations are applied within the sulcus. If necessary, antibacterial mouthwashes such as chlorhexidine can be used for gargling. In cases of acute gingival papillitis, the acute inflammation should be treated first. After the acute inflammation subsides, the above-mentioned methods should still be followed.
3. Maintenance of efficacy: After treatment begins, patients should be promptly taught methods to control dental plaque. They should persistently maintain oral hygiene and undergo regular follow-ups (every 6-12 months) and scaling to consolidate the treatment effects and prevent recurrence.

bubble_chart Prognosis

Gingivitis can be prevented by consistently and thoroughly removing dental plaque every day. Dental professionals should widely promote oral hygiene education, teaching patients the correct brushing techniques and the proper use of dental picks and floss. Maintaining a routine of brushing in the morning and evening, as well as rinsing after meals, helps control the formation of plaque and tartar. These practices are also crucial for preventing the recurrence of gingivitis.

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1. Should be differentiated from early periodontitis: The main distinguishing points are periodontal attachment loss and alveolar bone resorption. As mentioned earlier, in gingivitis, the gingival sulcus may deepen beyond 2mm, but the position of the junctional epithelial attachment remains at the cementoenamel junction. In periodontitis, however, the junctional epithelium has migrated apically, forming a true periodontal pocket with the base located apical to the cementoenamel junction. X-rays (especially bitewing radiographs) can help determine early alveolar bone resorption. In the early stages of periodontitis, a reduction in the height of the alveolar crest and the disappearance of the lamina dura can be observed, whereas in gingivitis, the bone height remains normal. When in doubt, X-rays should be taken to observe whether there is early resorption of the alveolar crest to differentiate early periodontitis.
2. Blood disorders: For patients whose main complaint is gingival bleeding and who also show signs of gingival inflammation, differentiation should be made from gingival bleeding caused by certain systemic diseases, such as leukemia, thrombocytopenic purpura, and aplastic anemia.
3. Necrotizing ulcerative gingivitis: This condition is characterized by gingival bleeding and pain, but its distinctive feature is necrosis of the gingival margin. For details, refer to the fourth key point in this section.
4. Acquired Immune Deficiency Syndrome-related gingivitis (HIV-G): This is one of the earliest associated symptoms in individuals infected with Acquired Immune Deficiency Syndrome. Clinically, a distinct bright red linear充血 (congestion) can be seen at the free gingival margin, and the attached gingiva may exhibit punctate erythema, with bleeding after brushing or spontaneous bleeding. Gingival充血 (congestion) does not subside even after the removal of dental calculus or plaque.