Clinical management of gingivitis

My previous post indicated that I approach gingivitis in my general dental practice, as a non-reversible disease entitiy. I have conluded from professional reading, dialogue with other practitioners and my clinical judgment and experience, that it is not a separate disease entity from periodontitis, just an early manifestation. Think about other conditions such as diabetes. When an individual is diagnosed with Type II diabetes, which accounts for 90-95% of all cases, they are commonly put on dietary control, not a regimen of oral meds and/or insulin, with frequent monitoring. The early manifestations of the disease commonly do not require intervention; however, if there is a lack of compliance, then more aggressive attention such as one or more medications will be necessary to achieve adequate glycemic control. Most importantly, a casual approach to the diabetes would be inappropriate and increase the likelihood of disease progression. If gingivitis is pro-actively approached as an early non-reversible manifestation of periodontitis, the likelihood of returning the patient to health is increased considerably. Assuming the cause of the gingivitis is poor biofilm control, rather than an exaggreated host response, having the patient describe their home care in detail is indicated, along with an examination of their risk factors (covered in an earlier blog post). Among the most important recommendations, in my opinion and experience, is recommending a power toothbrush. My preference is the Philips Sonicare Flexcare. I have seen consistently excellent results with its usage. Other recommendations would include an antimicrobial mouthrinse, my preference being Listerine, twice daily. Interdental cleaning tools such as floss, Proxabrushes, floss picks, rubber tip stimulators and so on are indicated as needed for specific patients. A tongue cleaner is another easy tool for patients to use to help reduce the total bacterial population in the mouth. Perhaps, most importantly is need for patient education. Taking the time to educate our patients on the importance of meticulous biofilm control, and the potential consequences of non-compliance will help the patient understand why it is so important to change home care habits. Monitoring at 30 day intervals should also be considered, tweaking the home care as needed. If gingivitis is present despite good biofilm control, DNA testing is indicated, including testing the bacterial DNA and perhaps the patient's genetic predisposition for perio disease (PST testing). Both salivary diagnostic tests are available from OralDNA Labs (OralDNA.com). This scenario will be discussed in a future blog post. As always, comments are welcome.
Richard H. Nagelberg, DDS
Every patient, every time, any level of gum disease