Gingivitis

Gingivitis is inflammation of the gingiva, which is part of the soft-tissue lining (gums) of the mouth that surrounds the teeth. Gingivitis is classified according to its appearance (ulcerative, purulent, hemorrhagic, or necrotizing), cause (hormonal, nutritional, drug- or plaque-induced), and whether it is acute or chronic. The most common type of gingivitis is chronic gingivitis, which results when plaque and tartar accumulate between the teeth. Acute necrotizing ulcerative gingivitis (ANUG) is also known as trench mouth. (See Acute necrotizing ulcerative gingivitis (ANUG).)

Gingivitis may progress to parodontitis, which is gum disease that spreads below the gum line and affects the tissue and bones that support the teeth.

Causes

Chronic gingivitis is generally caused by inadequate oral hygiene, which allows bacteria to remain between the teeth and plaque to build up on the teeth. ANUG is caused by organisms in the tissue and is not contagious. It may be a complication of chronic gingivitis, or it may be due to decreased immune defenses. Gingivitis may also be caused by drugs, such as anticoagulants, oral contraceptives, or calcium channel blockers; poor nutrition; allergic reactions; chronic disease; or lack of dental care. Tobacco use, diabetes mellitus, and human immunodeficiency virus infection may increase the incidence of gingivitis. Gingivitis may also be an early sign of hypovitaminosis, diabetes mellitus, and blood dyscrasias.

Acute Necrotizing Ulcerative Gingivitis (ANUG)

Acute necrotizing ulcerative gingivitis (ANUG), also known as trench mouth, Vincent’s stomatitis, or Vincent’s infection, after French physician Jean Hyacinthe Vincent, is an acute infectious type of gingivitis. It was common among trench-bound soldiers in World War II.

ANUG is caused by an abundance of oral bacteria, such as Prevotella intermedia, alpha-hemolytic streptococci, or Actinomyces species, among others. Contributing factors include poor diet, smoking, poor oral hygiene, lifestyle, stress, chemotherapy, diabetes, and an impaired immune system. If left untreated, necrotizing stomatitis may cause destruction of the periodontium, cheek tissue, lips, or bones of the jaws. The infection can also spread systemically to any other part of the body.

With ANUG, bleeding of the gums occurs spontaneously or with minimal local trauma. The patient may experience a metallic taste and have offensive breath. Local pain, fever, and malaise may also be reported. A gray pseudomembrane may be present on the gums, along with ulceration. ANUG is not contagious.

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