Differential diagnosis of gingivitis

Comprehensive examination of periodontal tissues

To conduct a proper differential diagnosis, it is necessary to assess the condition of the gingiva, periodontium, bone tissue of the alveolar processes, the body of the jaw, and the root cementum.

Basic methods include visual inspection, palpation, and probing using a periodontal probe. The physician records the following parameters:

• Condition of the gingival sulcus and the presence of periodontal pockets.
• Bleeding of the gums upon mechanical impact.
• Formation and discharge of exudate.
• Presence of bone resorption of the interdental septum.

In norm, the gingival sulcus is visually determined as a narrow slit, and the epithelial attachment to the tooth surface is completely undisturbed.

Clinical forms of gingivitis

When an inflammatory process develops, the clinical picture varies depending on the form of the disease:

1. Catarrhal gingivitis: the gingiva becomes inflamed, acquiring a bright red or pronounced cyanotic color. The marginal gingiva and gingival papillae increase in size, and patients note soreness.
2. Hypertrophic gingivitis: the gingival tissues become dense. The marginal gingiva and papillae are significantly enlarged and, in severe cases, can completely cover the tooth crown. The most important diagnostic sign of this form is the formation of false pockets. At the same time, the true epithelial attachment is not disturbed.

Differential diagnosis with periodontitis

The main difference between gingivitis and periodontitis lies in the integrity of the dentogingival junction. In periodontitis, the following pathological changes occur:

• True periodontal pockets are formed because the epithelial attachment is disrupted.
• Visual inspection and probing reveal soft plaque, supragingival and subgingival calculus. Various degrees of tooth mobility are determined.
• Upon palpation, the gingiva is painful, heavily bleeding, and exudate is released from the pockets.
• X-ray findings: resorption of the cortical plate of the interdental septum is detected. As it progresses, resorption of the septum itself occurs by 1/3, 2/3, or 1/2 of the root length.

Hygiene assessment and laboratory tests

Special dyes (Schiller-Pisarev solution, fuchsin, erythrosine) are used to detect dental plaque, microbial biofilm, and assess the degree of gingival inflammation. The evaluation mechanism is simple: in the presence of plaque, calculus, or inflammation, the tissues become stained. Using formulas, the Fedorov-Volodkina and Green-Vermillion (Green-Vermillion) indices are calculated.

Laboratory tests are prescribed strictly according to indications:

• Cytological, bacteriological, and histological.
• Complete blood count, blood chemistry, and urinalysis.
• Examination of oral fluid and gastric juice.

The purpose of these tests is the correct diagnosis and differential diagnosis of diseases of the oral mucosa, periodontium, salivary glands, and tumors.

Syndromic pathology in periodontal practice

Sometimes severe periodontal damage is a consequence of systemic diseases:

• Takahara syndrome: hereditary enzymopathy (absence of the catalase enzyme). Accumulation of hydrogen peroxide destroys tissues and promotes the growth of anaerobes. It is characterized by generalized gingival lesions and a rapid transition of gingivitis to periodontitis with the formation of deep pockets and tooth loss. The process does not stop even after tooth loss; necrosis of the oral mucosa and jawbones is possible.
• Sjögren's syndrome: insufficiency of exocrine glands. In the oral cavity, it manifests as dryness of the oral mucosa, xerostomia, burning tongue, tooth destruction, and a sharp enlargement of the parotid salivary glands.
• Severe infectious-allergic lesion: a continuous erosive bleeding surface of the oral mucosa with a fibrinous film. It differs from Fuchs syndrome by the obligatory presence of fever.

Class and exam questions

What else to study on this topic

• Takahara syndrome: pathogenesis of enzymopathy and causes of the rapid transition of gingivitis to severe periodontitis.
• Oral manifestations of Sjögren's syndrome: xerostomia, cheilitis, and tooth destruction.
• Urbach-Wiethe syndrome: deposition of protein-lipid complexes, nodules on mucous membranes, and prolonged retention of primary teeth.
• Rules for filling out the dental patient's medical record (Accounting Form No. 043/U).
• Facial anomalies in Turner syndrome ("sphinx face", hypertelorism).

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.