According to the Research: Say “Infection” Instead of “Inflammation” Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

The patient was a 13-year-old boy with severe gingivitis, more than a hundred bleeding points, and no interest in oral hygiene. He listened to what I had to say, but just didn’t seem moved to do anything about it. At the end of the visit I discussed the problem and need for better oral hygiene with his mother in hopes of getting her on my side. Mom didn’t seem to share my concerns either; I was not getting through to her! Why couldn’t I explain this so they both understood the problem was serious?

My frustration rose when Mom said, “Oh, I know he has some gingivitis, but inflammation isn’t so bad, really.”

Not so bad! What was she thinking? Gingivitis is a serious pathologic process. It’s periodontal disease. Why didn’t she get it? Out of frustration, I blurted out, “This infection is very serious and needs to be controlled before permanent damage occurs.” The look of shock on her face made me stop in my tracks.

“What do you mean, infection? You said he had gingivitis. You didn’t say he had an infection! Why didn’t you tell me he has an infection? What can we do about this infection?”

That’s when I learned the difference between “infection” and “inflammation.” Not the real difference, I knew that, but the value of the word “infection” when talking with patients. Mom thought gingivitis was just “inflammation,” which to her was not so bad. She’d had a bit of inflammation in her elbow once, and it resolved without any treatment. So gingivitis fit right into that category for her. A little “inflammation” was nothing to be concerned about. On the other hand, “infection” was serious and needed to be treated right away. Whatever I said after that she listened to intently. What a difference one word made!

Technically, “inflammation” more accurately describes the disease process going on. The “-itis” ending on words such as gingivitis and periodontitis indicates destruction resulting from an inflammatory process. Inflammation itself is a complex cascade of reactions leading to destruction of connective tissue and bone. In the case of periodontitis, the immune system actually causes the destruction of periodontal support, which, in the nature of it, comes about from inflammation, but that inflammation is triggered by infection.

The definition of infection is the invasion of the body by living pathogenic microorganisms which reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or antigen-antibody reaction in the host. This is the bacterial infection aspect of periodontal disease. In short, there can be inflammation without infection…but there can’t be infection without inflammation.

Confused? Consider this. Both infection and inflammation are taking place during periodontal pathogenesis. Subgingival bacterial biofilm accumulates and matures in the sulcus, releasing toxins that penetrate the junctional epithelium and pass into the underlying connective tissues, leading to infection. This infection triggers the immune response and begins the complex inflammatory process.

According to the research of Van Dyke, Offenbacher, Pihlstrom and others in 1999, tissue changes including redness and swelling are indicative of gingivitis, while bleeding upon probing should be considered an early sign of periodontitis. Sites that bleed are distinctly different from those characterized by redness.

Telling patients they have a bacterial infection gets results better than discussing inflammation. People often associate inflammation with something they can’t influence––like arthritis or a bruise. We know that periodontitis can be influenced.

If you’re trying to get people to own their own disease and therefore take responsibility for controlling and preventing it, link infection to each bleeding point. Instead of gingivitis, tell patients they have infection at each bleeding point. It’s much more impressive to have 23 areas of infection, rather than 23 bleeding points. Infection is perceived as a much more serious word that ties in the importance of the bacterial biofilm component.

Try to do what I learned to do: Pick words that will be sure to convey your message quickly and easily. Say “infection” instead of “inflammation.” In the case described, it did the trick. The boy and his mother got the message of the seriousness of the situation and asked for my advice on how to treat it. The oral hygiene instructions were followed and the gingivitis was reversed. One word made a big difference in the oral health of this boy.