Gingivitis
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Gingivitis is a non-destructive disease marked by inflammation of the gums.
Causes
- Plaque (most common)
- Poor oral hygiene
- Infection; Bacterial, Viral e.g. herpes simplex, measles
- Vitamin Deficiency
- Medicines and exposure to chemicals
- Trauma
- Allergic reaction
Signs and symptoms
- Bleeding gums or bleeding after brushing and/or flossing
- Bright red or purple gums
- Swollen and/or tender gums
- Bad breath (halitosis)
Differential diagnosis
- Gingival ulceration in leukaemia
- HIV-associated ulcerative gingivitis
Complications
- Periodontal disease
- Tooth Loss
Investigations
- Mouth smear may be helpful to identify causative organism
Treatment objectives
- Relieve pain and inflammation
- Treat infection
- Restore oral health
Non-pharmacological treatment
- Removal of irritating factors such as plaque, calculus, and faulty dentures
- Warm saline mouthwash
Pharmacological treatment
First Line
NSAIDs such as Ibuprofen, oral;
Adult:
200-400mg every 8 hours
Child:
100-200mg every 8 hours
For infected ulcers
Amoxicillin oral:
Adult:
500mg every 8 hours;
Child:
6-12 years: 250mg every 8 hours,
1-5 years: 125mg every 8 hours,
<1 year: 62.5mg every 8 hours for 5 days
AND
Metronidazole oral
Adult:
400mg every 8 hours
Child:
7-10 years: 200mg every 8 hours,
3-7 years: 100mg every 8 hours,
1-3 years: 50mg every 8 hours for 5 days
OR
Co-amoxiclav oral
Adult:
625mg every 12 hours
Child:
6-12 years: 5ml of 400/57 suspension every 12 hours
1-6 years: 2.5ml of 400/57 suspension every 12 hours
1 month-1 year: 0.25ml/kg of 125/31 suspension every 8 hours
Neonates: 0.25ml/kg of 125/31 suspension every 6 hours for 7 days
Prevention
- Maintain regular oral hygiene
- Regular Scaling and Polishing every six (6) months
- Use of antibacterial mouthwashes
Referral
- Extensive and ulcerative gingivitis to a dental specialist
- Presence of calculus for scaling and polishing of the teeth.