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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 interdental papilla (Figure 41-1). 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.


Chronic gingivitis in which the interdental 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 (see Figure 41-1).

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 41-2, 41-3, 41-4).


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


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


Severe periodontal disease in a man addicted to tobacco and alcohol. Note the edematous and blunted interdental 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 45.9% of adults 30 years of age or older in the United States have periodontal disease. In that overall population, 8.9% have a severe form.1

  • The prevalence and severity of periodontitis is increased in Hispanic, non-Hispanic black, Asian, low–socioeconomic status, and smoker populations. The prevalence increases with age, reaching 70% for the age group >65 years, ...

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