Plaque induced diseases

Bleeding after pocket probing

Acute gingivitis

Plaque deposits on tooth 22

Gingivitis caused by plaque alone is an infection of the gums (gingiva). Its cause is soft bacterial plaque. The main symptom of gingivitis is bleeding. Inflamed gingiva can bleed even if plaque is removed with a soft brush or even for no apparent reason. Healthy gingiva is characterised by specific stippling, similar to the surface of an orange.

Healthy gingiva is pale pink. If inflamed, the colour becomes a deeper red. Except in severe parodontal diseases, patients hardly ever complain of pain.

The clinical symptoms of gingivitis caused by plaque accumulation are reddening, swelling and loss of stippling. The inflammation recedes once the plaque and pigmentation are removed and prophylactic consultation on the brushing technique has occurred.

Apart from gingivitis caused solely by the presence of plaque, there are gingivitides arising from systemic factors (factors concerning the entire organism). A typical example is a gum infection during pregnancy. Hormonal change phases (puberty, menstruation, and pregnancy) influence the immune system and lead to modification of inflammatory processes in the gingiva.

Neben der Gingivitis, die allein durch die Anwesenheit von Plaque verursacht wird, gibt es Gingivitiden, die durch systemische (also den ganzen Organismus betreffende) Faktoren entstehen. Typisches Beispiel ist die Zahnfleischentzündung während der Schwangerschaft. Hormonelle Umbruchphasen (Pubertät, Menstruation, Schwangerschaft) beeinflussen das Immunsystem und führen zur Abwandlung entzündlicher Vorgänge an der Gingiva.

Extensive parodontitis marginalis

Gingival bleeding after careful initial plaque removal

Plaque as cause for gingivitis

Condition after prophylactic measures

Inflamed interdental papillae

Gingival hyperplasia due to intake of drugs

Hyperplastic gingivitis after intake of drugs

Drugs can modify plaque-related gingivitis. Inflammatory hyperplastic changes occur most frequently in connection with antiepileptica (convulsion disorder drugs) and Ca-canal blockers (heart medication). These cause gingival hyperplasia. The inflammation, accompanied by tissue increase, can be so severe that the teeth are completely covered by proliferous gingiva. Oral contraceptives (e.g., the "pill") can also cause gingivitis.

Hyperplastic gingivitis in leukaemia

The sub-group of gingivitides modified by system diseases further include those in diabetic patients (diabetes mellitus) and those in patients with blood count disorders (e.g., leukaemia).
However, plaque-related gingivitides modified due to malnutrition (e.g., chronic lack of vitamins A, C and D) are rare in Europe.