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A 35-year-old woman presents to clinic for a routine physical examination. She says that for the last 6 months her gums bleed when she brushes her teeth. She reports smoking 1 pack of cigarettes per day. The oral examination finds generalized plaque and red swollen intradental papilla (Figure 39-1). The physician explains to her that she has gingivitis and that she should brush twice daily and use floss daily. The physician tells her that smoking is terrible for her health in all ways, including her oral health. The physician offers her help to quit smoking and refers her to a dentist for a cleaning and full dental examination.

Figure 39-1

Chronic gingivitis in which the intradental papillae are edematous and blunted. There is some loss of gingival tissue. The gums bleed with brushing. (Reproduced with permission from Gerald Ferretti, DMD.)

Gingivitis is the inflammation of the gingiva (gums). Gingivitis alone does not affect the underlying supporting structures of the teeth and is reversible (Figure 39-1).

Periodontitis (periodontal disease) is a chronic inflammatory disease, which includes gingivitis along with loss of connective tissue and bone support for the teeth. It damages alveolar bone (the bone of the jaw in which the roots of the teeth are connected) and the periodontal ligaments that hold the roots in place. It is a major cause of tooth loss in adults (Figures 39-2, 39-3, and 39-4).

Figure 39-2

Healthy periodontal anatomy versus periodontal disease. (Reproduced with permission from the American Academy of Periodontology;

Figure 39-3

Severe periodontal disease in a woman who smokes and is addicted to cocaine. Note the blunting of the intradental papillae and the dramatic loss of gingival tissue. (Reproduced with permission from Richard P. Usatine, MD.)

Figure 39-4

Severe periodontal disease in an alcoholic smoker with very edematous and blunted intradental papilla. This homeless man has already lost two teeth secondary to his severe periodontal disease. (Reproduced with permission from Richard P. Usatine, MD.)

  • Gingivitis and periodontal diseases are the most common oral diseases in adults.
  • It is estimated that 35% of adults 30 years of age or older in the United States have periodontal disease: 22% have a severe form and 13% have a moderate-to-severe form.1
  • Homeless persons are a very high-risk group for gingivitis, periodontitis, and all dental disease (Figure 39-4).
  • Periodontal disease has been shown in some studies to be an associated factor in coronary heart disease and chronic kidney disease.2
  • Periodontal disease in pregnancy is associated with an increase in preterm ...

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