Clinical Signs of Gingivitis

Brook A. Niemiec DVM Diplomate, ADVC Diplomate DEVDC Fellow AVD Veterinary Dental Specialties and Oral Surgery San Diego, Murrieta, Irvine, Ontario, Santa Barbara, Las Vegas, New Orleans The level of gingival inflammation is broken down into several stages. However, these stages are somewhat arbitrary and gingivitis proceeds through them in a fluid fashion, with no clear demarcations. This newsletter will discuss the clinical signs associated with initial to advanced gingivitis. The initial events in gingivitis are actually changes in the gingival vasculature, specifically increased blood flow through dilated capillaries. These capillary changes occur within 7 days (but can start as soon as 48 hours) after plaque has been allowed to accumulate. This low level of inflammation is NOT clinically evident, and therefore is known as subclinical gingivitis. This first clinical stage occurs approximately one week following the initiation of plaque accumulation. Classically, the first clinical sign of gingivitis was believed to be a color change caused by erythema of the gingival margin, termed “marginal gingivitis” (Figure 1). This is caused by the proliferation of capillaries as well as formation of capillary loops. This stage of gingivitis may be present with or without demonstrable plaque and calculus. This initial level of gingivitis is classified as gingival index (GI) 1.