Clinical Manifestations
Clinical Manifestations
The clinical hallmarks of gingivitis are: erythema (redness from increased vascularity and vasodilation), edema (puffiness, loss of the sharp, knife-edged gingival margin), and bleeding on probing (BOP). BOP is the most sensitive clinical indicator of gingival inflammation — healthy gingiva does not bleed on probing with normal force (25g).
The gingival contour changes from the healthy scalloped, knife-edged margin to a swollen, rounded, bulbous margin. The stippled, orange-peel texture of healthy attached gingiva is replaced by a smooth, shiny surface due to edema and loss of rete peg-dermal interdigitation.
Patients commonly report bleeding while brushing or eating (spontaneous bleeding only in severe cases), bad breath (halitosis from bacterial metabolism in plaque), and occasionally gum soreness. Many patients with chronic mild gingivitis are asymptomatic — they notice bleeding only when pointed out by a clinician.
NUG presents dramatically: the patient reports severe gingival pain, spontaneous bleeding, and pronounced halitosis. Examination reveals 'punched out' crateral ulceration of interdental papillae covered by a gray-white pseudomembrane of necrotic tissue. Systemic signs (fever, malaise, lymphadenopathy) accompany severe cases.