Hormonally Modulated Gingivitis


Hormonally Modulated Gingivitis

Types I A 2 a

Changes in the body’s hormonal balance generally do not cause gingival inflammation, but can increase the severity of an already existing plaque-induced gingivitis. In addition to insulin deficiency (Diabetes mellitus; pp. 132, 215), it is primarily the female sex hormones that often are associated with the progression of plaque-elicited gingivitis:

  • Puberty gingivitis

  • Pregnancy gingivitis

  • Gingivitis from the “Pill” (rare)

  • Gingivitis menstrualis and intermenstrualis

  • Gingivitis climacterica

Puberty Gingivitis

Epidemiologic studies have demonstrated that gingival inflammation during puberty is somewhat more pronounced when compared to the years preceding and following puberty (Curilović et al. 1997, Koivuniemi et al. 1980, Stamm 1986). If oral hygiene is poor and/or if the adolescent is a mouth breather, a typical gingival hyperplasia may ensue, especially in the maxillary anterior area (Figs. 178 and 179). Therapy: Oral hygiene instruction, plaque and calculus removal; gingivoplasty if the hyperplasia is severe. Mouth breathing may require consultation with an appropriate medical specialist (ENT).

Pregnancy Gingivitis

This condition is not observed in every pregnant woman. Even if oral hygiene is good, however, the gingivae will exhibit an elevated tendency to bleed (Silness & Löe 1964). Therapy: Oral hygiene; recall every one to two months until breast-feeding is discontinued.

“Pill” Gingivitis

Gingival reaction to oral contraceptives is rare today (Pankhurst et al. 1981). Symptoms: Slight bleeding, rarely erythema or swelling.

Therapy: Oral hygiene.

Gingivitis Menstrualis/Intermenstrualis

This gingival condition is exceedingly rare. Desquamation of gingival epithelium occurs during the twenty-eight day menstrual cycle, similar to vaginal epithelium. In exceptional cases, the desquamation can be so pronounced that a diagnosis of “discreet” gingivitis may be made, even less frequently gingivitis menstrualis or intermenstrualis (Mühlemann 1952).

Therapy: Good oral hygiene to prevent secondary plaque-associated gingivitis.

Gingivitis Climacterica

This alteration of the mucosa is also rare. The pathologic alterations are observed less on the marginal gingiva than on the attached gingiva and oral mucosa, which may appear dry and smooth, with salmon-pink spots. Stippling disappears and keratinization is lost. Patients complain of xerostomia and a burning sensation.

Therapy: Careful oral hygiene (pain!), and topical vitamin Acontaining ointments and dentifrices. In severe cases, the gynecologist may elect to intervene by means of systemic estrogen supplements.

The following pages depict puberty gingivitis and pregnancy gingivitis.


178 Puberty Gingivitis In this 13-year-old female, more or less severe hemorrhage occurred after gentle sulcus probing. Plaque and mouth breathing were causes of the gingival inflammation. The pubertal hormonal surge may have been a cofactor. Right: Morbidity of gingivitis in 10,000 persons. A peak is observed during puberty (Stamm 1986).
179 Puberty Gingivitis, Orthodontic Treatment This 13-year-old male lost his maxillary central incisors due to an accident. Gingivitis, possibly puberty-related, was present before the accident. Orthodontic means were used to move the lateral incisors mesially. In the absence of adequateplaque control, a severe inflammatory hyperplasia occurred between the maxillary lateral incisors.


180 Mild Pregnancy Gingivitis In this 28-year-old female, who was in her seventh month of pregnancy, a cursory inspection did not reveal symptoms of gingivitis in the anterior region. In the premolar and molar areas, however, a moderate gingivitis was detected. Right: Copious hemorrhage occurred immediately after probing in the area of a defective restoration (plaque niche).
181 Severe Pregnancy Gingivitis This 30-year-old patient exhibited moderate gingivitis even before her pregnancy. This photograph, taken during the eighth month, reveals severe inflammation and pronounced hyperplastic, epulislike gingival alterations in the anterior segment.
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Jul 2, 2020 | Posted by in Dental Hygiene | Comments Off on Hormonally Modulated Gingivitis
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