Plaque/biofilm is responsible for the initiation of the disease process and systemic factors modify the host’s immune system response. These systemic factors do not cause gingivitis but may act to intensify it. Treatment of this classification of gingivitis involves getting the systemic condition or disease under control first and then professional debridement and personal biofilm control.
Gingival Diseases Associated with the Endocrine System
Changes in hormone levels allow for an exaggerated response to plaque/biofilm. Hormonal-influenced gingivitis (puberty-, menstrual cycle- and pregnancy-associated gingivitis and pyogenic granuloma) and poorly controlled blood glucose levels (diabetes mellitus-associated gingivitis) may increase the inflammatory response of the gingiva to plaque/biofilm.
Gingival Diseases Associated with Blood Dyscrasias
Blood dyscrasias are an abnormal function or number of blood cells. There are a number of blood dyscrasias that present problems for the patient. Leukemia-associated gingivitis is typically the one the dental team encounters. Gingival changes can occur rapidly and may cause the patient to seek dental advice, not realizing the changes have a medical, rather than dental, origin.
In leukemia-associated gingivitis, there is an abnormal increase in leukocytes (white blood cells) in the blood and bone marrow. Patients with leukemia may exhibit gingival bleeding and enlargement that starts in the interdental papilla and spreads to the attached gingiva.
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