Gingivitis in a common oral disease, reported to affect 4 of 5 adults across the globe (Beaglehole 2009). The onset of gingivitis follows the accumulation of dental plaque and can be evident as early as 48 hours after dental plaque begins to form (Figure 3). Gingivitis can be prevented by maintaining low levels of plaque, and it can also be reversed (Tonetti et al. 2015).
Plaque produces an inflammatory reaction in the gingival tissues that results in increased blood flow and dilation of blood vessels. This is accompanied by an increase in all types of inflammatory cells, leading to swelling and reddening of the tissues after 48–96 hours. Continued exposure to plaque bacteria and their byproducts, such as metabolic toxins and proteolytic enzymes, promotes further inflammation and swelling, as well as engorgement and stasis of blood flow giving the tissues a bluish or purplish hue after fourteen to twenty- one days. At this point it is defined as an established gingivitis and it is not associated with irreversible damage. Without intervention, it may remain stable or progress to periodontitis with loss of attachment and destruction of the alveolar bone.
Figure 3. Gingivitis with redness and swelling
There are three ways in which gingivitis reductions can be achieved:
Gingivitis affects 4 of 5 adults globally
The reductions in gingivitis observed with stabilized stannous fluoride dentifrice are due to the broad-spectrum anti-bacterial activity of stannous fluoride (Ramji et al. 2005). Stannous fluoride inhibits bacterial metabolism, and thus reduces bacterial growth, bacterial adhesion and the production of toxins that potentiate gingival inflammation (Ramji et al. 2005, White 1995). Stannous fluoride also reduces the virulence of plaque by blocking the reactivity of LPS with tissue receptors that trigger inflammation (Haught et al. 2016a).
The stannous ion has high substantivity in the oral cavity, imparting a long-lasting antibacterial effect (Scott et al. 2009). Stannous levels in plaque remain above levels that are sufficient to inhibit metabolic activity up to twelve hours after exposure (Ramji et al. 2005). Otten et al. (2012) demonstrated that twelve hours after brushing with stabilized stannous fluoride dentifrice, plaque samples retained enough residual anti-bacterial activity to inhibit fresh, unexposed plaque samples. Given that dental plaque is associated with gingivitis, reducing and inhibiting plaque contributes to reductions in gingivitis. Retention of the stannous ion in plaque that remains after oral hygiene is important since the plaque that is missed during brushing is often in hard-to-reach areas where removal matters most to prevent the build-up of plaque and the onset of gingivitis.