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:
Gingivitis from the “Pill” (rare)
Gingivitis menstrualis and intermenstrualis
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).
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.
Gingival reaction to oral contraceptives is rare today (Pankhurst et al. 1981). Symptoms: Slight bleeding, rarely erythema or swelling.
Therapy: Oral hygiene.
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.
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.