Gingivitis Clinical Presentation

Updated: Jan 18, 2018
  • Author: James M Stephen, MD, FAAEM, FACEP; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Historical findings depend on whether the patient has chronic gingivitis or ANUG.

  • Chronic gingivitis

    • The most common complaint is bleeding gums. The patient usually notices this when toothbrushing or flossing.

    • Bleeding may be associated with eating, especially foods with a hard consistency, such as apples or crusted bread. These foods may rub against gums.

  • Acute necrotizing ulcerative gingivitis

    • Apparently spontaneous bleeding or bleeding in response to very minimal local trauma may occur.

    • ANUG also may produce local pain, malaise, and alterations in taste, such as a metallic flavor.

    • ANUG may produce foul breath.



See the list below:

  • Chronic gingivitis

    • Patients have minimal physical findings aside from local findings at the dental-gingival margins.

    • Gingival pockets may be detected with a periodontal probe. However, the pocket depth may be overestimated when periodontitis is present and underestimated in healthy gums.

    • Mild bleeding from the gum margins may occur with any manipulation.

  • Acute necrotizing ulcerative gingivitis

    • Fever, halitosis, marked gingival edema, and ulceration, especially in the interdental papillae, may be present.

    • A grey pseudomembrane may be present.

    • Infection may spread to adjacent soft tissues of the mouth, with noticeable erythema, edema, tenderness, and induration of affected areas.

  • Reaction to oral contraceptives (see Causes)



See the list below:

  • Although bacteria play a role in all forms of gingivitis, the primary cause of chronic gingivitis is inadequate oral hygiene.

  • Risk factors

    • Use of tobacco or ethanol is thought to be a risk factor.

    • Immune incompetence is observed more frequently in HIV-infected children. As their CD4 counts decline, incidence of gingivitis may increase. Diabetes mellitus increases the risk of gingivitis and periodontitis.

  • Drug-induced causes

    • The list of drugs that cause gingivitis and gingival bleeding is extensive.

    • Gingival bleeding may occur with the use of anticoagulants and fibrinolytic agents.

    • Phenytoin, oral contraceptive agents, and calcium channel blockers may cause gingival hyperplasia.

    • Gingivitis has been observed with use of protease inhibitors (eg, saquinavir, ritonavir), vitamin A and analogues, danazol, pentamidine, misoprostol, methotrexate, and gold compounds.

    • Gingivostomatitis has been observed in exposure to arsenic, gold, bismuth, mercury, nickel, sulfur dioxide, lead, thallium, zinc, methyl violet, and topical chlorhexidine.

  • Acute necrotizing ulcerative gingivitis

    • Acute necrotizing infection may occur as a complication of chronic gingivitis in situations in which hygiene is abandoned completely or host defenses are weakened.

    • ANUG is the result of soft tissue invasion by ubiquitous organisms and is not believed to be contagious.

    • It is a risk wherever poor sanitation, diet, or oral hygiene is present.

    • Living near livestock is an additional risk factor.

  • Other causes

    • Inadequate plaque removal

    • Blood dyscrasias

    • Allergic reactions

    • Chronic debilitating disease

    • Poor nutrition

    • Lack of periodic dental examinations