Gingivitis is defined as an inflammation which is confined to the tissues of the marginal gingiva . It is an observable alteration in tissues associated with changes in vascular permeability and dilation often accompanied with the infiltration of leukocytes into the affected tissues .

The sequence of events cumulating in the clinically apparent gingivitis is categorized into

• STAGE 1: Initial lesion
• STAGE 2 : Early lesion
• STAGE 3 : Established lesion
• STAGE 4 : Advanced lesion

STAGE 1 : THE INITIAL LESION ( 2- 4days ):

1. VASCULAR CHANGES : Classic vasculitis sub adjacent to junctional epithelium, dilated capillaries , increased blood flow
2. MICROSCOPIC CHANGES : Presence of leukocytes, loss of perivascular collagen and presence of serum proteins changes in the coronal most position of junctional epithelium .
3. CLINICAL CHANGES : Exudation of fluids from the gingival sulcus , sub clinical gingivitis .

STAGE 2 : EARLY LESION (4-7 DAYS ):

1. VASCULAR CHANGES : Vascular proliferation
2. MICROSCOPIC CHANGES : Rete pegs formation in junctional epithelium , presence of lymphocytes , loss of collagen is increased , fibroblasts show cytoplasmic alterations .
3. CLINICAL CHANGES : Bleeding on probing, erythematous gingiva.

STAGE 3 : ESTABLISHES LESION ( 14-21 DAYS ) :

1. VASCULAR CHANGES : Same as early lesion with blood stasis.
2. MICROSCOPIC CHANGES: Proliferation , apical migration and lateral extension of junctional epithelium, atrophic areas , plasma cells are predominant , further loss of collagen, increased enzyme levels of acid and alkaline phosphatase.
3. CLINICAL CHANGES : Changes are seen in color, surface texture and consistency , bluish hue around the reddened gingiva , gingiva appears to be moderately to severely inflamed .

STAGE 4 : THE ADVANCED LESION :

1. VASCULAR CHANGES: Same as early and established lesions. characterized by the invasion of the lesion to the underlying alveolar bone .
2. MICROSCOPIC CHANGES: Persistence of features seen in established lesion, extension of inflammation into deeper structures including alveolar bone and periodontal ligament , presence of all types of inflammatory cells , conversion of bone marrow into fibrous tissues.
3. CLINICAL CHANGES :Formation of periodontal pocket and its associated changes.

REFERENCES: ESSENTIALS OF PERIODONTOLGY SHANTIPRIYA REDDY 5TH EDITION

INTRODUCTION:

Halitosis – or chronic bad breath – is something that mints, mouthwash or a good brushing can’t solve. Unlike “morning breath” or a strong smell that lingers after a tuna sandwich, halitosis remains for an extended amount of time and may be a sign of something more serious. 

CLASSIFICATION :

1. BASED ON ETIOLOGY :

• Local factors of pathological origin : poor oral hygiene , extensive caries, periodontal disease , cysts , tumors .
• Local factors of non pathological origin : stagnation of saliva associated with food debris , dentures, excessive smoking .
• Systemic factors of pathological origin : diabetes mellitus, liver failure, lung abscess , tuberculosis .
• Systemic factors of non pathological origin : diet like garlic , onion , meat , excessive alcohol consumption.
• Xerostomia :conditions like sjogren’s syndrome, radiation therapy.

2. BASED ON PATIENT’S CRITERIA :

• Genuine halitosis
• Pseudo halitosis
• Halitophobia

PATHOGENSIS OF MALODOR :

ETIOLOGY :

1. Physiological halitosis

• mouth breathing
• medications
• aging and poor dental hygiene
• fasting / starvation
• tobacco
• foods like onion , garlic and alcohol

2. Pathological halitosis:

• periodontal infection
• stomatitis
• xerostomia
• faulty restorations
• unclean dentures
• oral cancers
• candidiasis
• nasal infections
• GERD
• bronchitis, pneumonia
• diabetes mellitus
• renal failure
• fever

DIAGNOSIS :

1. Review of medical , dental , personal history
2. Clinical examination : tongue coating, mouth breathing , xerostomia
3. Complete periodontal examination
4. Measurement of malodor : gas chromatography . halimeters, BANA test , chemiluminescence , diamond probe

TREATMENT :

• Brush your teeth after you eat.
• Floss at least once a day.
• Brush your tongue.
• Clean dentures or dental appliances. .
• Avoid dry mouth.
• Adjust your diet. .
• Regularly get a new toothbrush.
• Schedule regular dental checkups.
• Regular use of halita solution which reduces the levels of volatile sulfur compounds .

References: Essentials of clinical periodontology . Shantipirya reddy 5th edition