Inflammation involving the squamous mucosa, or gingiva, and associated soft tissues that surround teeth is defined as gingivitis. Poor oral hygiene, which facilitates buildup of dental plaque and calculus between and on the surfaces of teeth, is the most frequent cause of gingivitis. Dental plaque is a sticky biofilm composed of bacteria, salivary proteins, and desquamated epithelial cells. As it accumulates, plaque becomes mineralized to form calculus, or tartar. In chronic gingivitis, this is accompanied by gingival erythema, edema, and bleeding. Gingivitis may occur at any age but is most prevalent and severe in adolescence, where it is present in 40% to 60% of individuals, after which the incidence tapers off. Fortunately, gingivitis can be reversed, primarily by regular brushing and flossing of teeth which reduces accumulation of plaque and calculus.
Periodontitis is an inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum. With progression, periodontitis may result in destruction of periodontal ligament and alveolar bone and eventual tooth loss. Periodontitis is associated with poor oral hygiene that affects the composition of gingival bacteria. Facultative Gram-positive organisms are found at healthy sites, while anaerobic and microaerophilic Gram-negative bacteria colonize plaque within areas of active periodontitis. Although about 300 bacterial species reside within the oral cavity, periodontitis is most closely associated with Aggregatibacter (Actinobacillus) actinomycetemcomitans, Porphyromonas gingivalis, and Prevotella intermedia.
•Cariesisthemostcommoncauseoftoothlossinindividualsyoungerthan35yearsofage.Theprimarycauseisdestructionoftoothstructurebyacidendproductsofsugarfermentationbybacteria.
Gingivitisisacommonandreversibleinflammationofthemucosasurroundingtheteeth.Itisassociatedwithbuildupofdentalplaqueandcalculus.
Periodontitisisachronicinflammatoryconditionthatcanleadtothedestructionofthesupportingstructuresoftheteethwitheventuallossofdentition.Itisassociatedwithpoororalhygieneandalteredoralmicrobiota.
These common superficial mucosal ulcerations affect up to 40% of the population. They are more frequent in the first 2 decades of life, extremely painful, and often recur. Although the cause of aphthous ulcers is unknown, they tend to be familal and may be associated with celiac disease, inflammatory bowel disease, and Behçet disease. Ulcers can be solitary or multiple; typically, they are shallow, with a hyperemic base covered by a thin exudate and rimmed by a narrow zone of erythema (
Fig. 15.1 ). In most cases they resolve spontaneously in 7 to 10 days but can recur.