Causes of gingiva bleeding, Treatment plan of chronic gingivitis


What is Gingivitis?

Inflammation of superficial structure of periodontium ie. GCT (gingiva connective
tissue) and .superficial fibre of PDL without loss or damage.

Causes of gingival bleeding:

A. Local cause
i. Gingivitis
ii. Periodontitis
[These are the chronic inflammation of the gingiva. Gingiva at these stages arc
hyperemic edematous. Ulcerated. SO. Spontaneous BOP occurs.]
iii. Mechanical trauma by toothbrush/ pick or food impaction
IV. Hemangioma of jaw

gingival bleeding
B). Systemic cause:
i. Aplastic anemia:: Platelet count decreased which is an important factor for coagulation. So. Bleeding occurs.
ii. Leukemia: Platelet count is increased.
iii. Scurvy: Due to vit C deficiency
iv. Bleeding disorders:

Hemophilia A
Hemophilia B

Purpura: ITP
: Thrombasthenia
: Thrombocytopathy
: Von Willebrand’s disease
: Christmas diseases.

v. Anticoagulant therapy: Heparin
vi. Liver Diseases
vii. Vit – K deficiency
viii. Multiple myeloma
ix. Uraemia
x. Salicylates drugs.

Clinical features of gingiva:

i. Bleeding from the gum.
ii. Color: Red or red blue
iii. Contour: Thick and rolled.
iv. Consistency: swollen, oedematous, spongy
v. Surface texture: Loss of surface stippling, smooth & shiny or firm & nodular surface.
vi. Papillae: Enlarged, elongated, proliferated.
vii. Anorexia
viii. Halitosis/ bad odour/ foul smelling:

Clinical features of gingiva

a) Local cause-

                1. gingival/ periodontal inflammation (ie. Bad oral hygiene)
                  ii. Food-spice, smoking, drugs.

b) Systemic-

                1. Sinusitis
                  ii. Salivary glands infection, Tonsilitis, Pharyngitis
                  iii. URTI (Upper respiratory tract infection), LRTI
                  iv. Gastritis and Gastric upset or regurgitation
                  v. Liver diseases (eg. Cirrhosis)
                  vi. Nephritis and Nephrotic syndromes.
                2. Salivation: Increased.
                  x. Marginal papilla: Enlarged, oedematous
                  xi. Sulcular depth: Increased.
                  xii. GCF: Increased.
                  xiii. BOP:

“Moderate (+): 1-3 minute
Moderate & severe (++): 5 second- 1 minute
Spontaneous bleeding (+++) : 0.5 second”

Histopathology of Chronic gingivitis:

i. Hyperaemia (increased blood flow -> engorged blood capillary stasis)
ii. Infiltration of defense cells, especially neutrophil, lymphocytes around the corium.
iii. Loss of collagen
iv. Thining of overlying gingival epithelium due to the proliferation of rete ridges in lamina

Differential diagnosis of gingivitis:

As bleeding occurs in gingivitis which is similar to:

  1. Aplastic anaemia
  2. Leukaemia
  3. Haemophilia – A, B.
  4. Von wille brand’s diseases.
  5. Purpura
  6. Christmas diseases.
  7. Scurvy
  8. Anticoagulant therapy taking patient.
  9. Liver Diseases.
  10. Vit K- deficiency.
  11. Multiple myeloma
  12. Uraemia

The treatment plan of chronic gingivitis:

i. Chronic mild gingivaOHI (Oral Hygiene Instruction) + Maintenance
ii. Chronic moderate gingivitisOHI+ Scaling + polishing + maintenance
ii. Chronic severe gingivitisOHI + Scaling + polishing + maintenance

Note: If ulceration is profound then Tab metronidazole- 200g
1+1+1- for 3 days

Gingivitis index:




0No inflammation:
a) Normal gingiva
No treatment
1Mild inflammation:
a) Slightly marginal erythema
b) No bleeding on probing
i. Oral hygiene instruction
ii. Maintenance
2Moderate inflammation:
a) Marginal papilla become redness with slight swelling.
b) Oedema
c) BOP present
i. oral hygiene instruction
ii. Scaling
iii. Polishing
iv. maintenance
3Severe inflammation:
a) Marginal papilla oedematous, enlarged, ulceration
b) Spontaneous BOP
i. oral hygiene instruction
ii. Scaling
iii. Polishing
iv. maintenance



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