What is gum disease (gingivitis)?
Gingivitis, the earliest stage of gum disease, is inflammation of the tissues surrounding and supporting the teeth and is most commonly a result of poor dental hygiene. Gingivitis is a prevalent condition and varies widely in severity. It is characterized by red, swollen gums that bleed when teeth are brushed or flossed. Gingivitis is not the same thing as periodontitis. Gingivitis always precedes and acts as a warning sign for the more severe condition of periodontitis.
Gingivitis starts when food debris mixes with saliva and bacteria, which, in turn, forms dental plaque that sticks to the surfaces of teeth. If dental plaque isn't removed by brushing with toothpaste and flossing, it can become mineralized and form tartar, or calculus. Tartar is very hard, and only professional dental cleaning can remove it.
Dental plaque and tartar are filled with harmful bacteria, and if they aren't removed from teeth, they will begin to irritate the gums and cause gingivitis. If left untreated, gingivitis will often extend from the gums to the bone and lead to periodontitis.
What is the difference between gingivitis and periodontitis?
While gingivitis is inflammation of the gums around the teeth, periodontitis occurs when the bone below the gums gets inflamed or infected. Periodontitis derives from the word periodontal, which means "around the tooth" and refers to the structures surrounding and supporting teeth, such as gum and bone. Periodontology is the study of the supporting structures of the teeth.
When the underlying bone gets infected, the gums will recede away from the teeth and form deep gum pockets called attachment loss. These pockets readily collect plaque and bacteria. More bone loss occurs because these pockets are tough to keep clean.
As periodontal disease progresses into later stages (early, moderate, and advanced) and more bone tissue is lost, the gum pockets deepen. The teeth may eventually become loose and fall out.
What causes gum disease?
Improper oral hygiene that allows bacteria in plaque and calculus to remain on the teeth and infect the gums is the primary cause of gum disease. But other factors increase the risk of developing gingivitis. Here are some of the most common risk factors:
Smoking or chewing tobacco prevents the gum tissue from being able to heal.
Crooked, rotated, or overlapping teeth create more areas for plaque and calculus to accumulate and are more challenging to keep clean.
Hormonal changes in puberty, pregnancy, and menopause typically correlate with a rise in gingivitis. The increase in hormones causes the blood vessels in the gums to be more susceptible to bacterial and chemical attacks. At puberty, the prevalence of gingivitis ranges between 70%-90%.
Cancer and cancer treatment can make a person more susceptible to infection and increase the risk of gum disease.
Alcohol negatively affects oral defense mechanisms.
Stress impairs the body's immune response to bacterial invasion.
Mouth breathing can be harsh on the gums when they aren't protected by the lips, causing chronic irritation and inflammation.
Poor nutrition, such as a diet high in sugar and carbohydrates and low in water intake, will increase plaque formation. Also, a deficiency of essential nutrients such as vitamin C will impair healing.
Diabetes mellitus impairs circulation and the gums' ability to heal.
Medications such as antiseizure medications increase the risk for gum disease.
Infrequent or no dental care.
Poor saliva production.
Does gum disease cause bad breath?
Bad breath, or halitosis, is most frequently associated with gum disease. The oral bacteria present in the mouth release chemical gases called volatile sulfur compounds with a strong odor.
Bad breath can also come from the bacterial plaque that builds upon the tongue. Halitosis can be eliminated when the plaque and tartar are removed from the teeth and tongue with regular brushing, flossing, and professional dental cleanings. This is the easiest way to reverse bad breath, but it can take a while for the mouth odor to disappear completely.
A person needs to be consistent and persistent with oral hygiene to change the condition.
Other causes of bad breath include:
Partially erupted wisdom teeth
Dry mouth
Mouth breathing
Post-nasal drip
Infections in the throat or lungs
Tonsil stones
Smoking
Digestive problems
Systemic diseases like diabetes
Symptoms and signs of gum disease
A person with gum disease will typically have one or more of the following signs and symptoms:
Bright red, swollen gums that bleed very quickly, even during brushing or flossing
Bad taste or persistent mouth odor
White spots or plaques on the gums
Gums that look like they're pulling away from the teeth
Pus between gums or interdental spaces
Change in the way teeth fit together in the mouth or spaces opening up between teeth
Loose teeth or tooth loss
Change in the way partial dentures fit
As gingivitis progresses (chronic gingivitis), various complications may arise. If gingivitis advances to periodontitis, the affected person may develop receding gums or areas where the tooth's root becomes uncovered by the shrinking, diseased gums. Deep pockets may also develop around the teeth that trap food, plaque, and debris.
As periodontitis develops, the person may lose gum tissue or bone around the teeth, and the teeth may become loose or fall out. These changes can grow very slowly or very rapidly and affect either a few teeth or the entire mouth.
If oral hygiene is rarely performed or if the person becomes immune-compromised, acute necrotizing ulcerative gingivitis can develop (ANUG, formerly termed trench mouth). ANUG is a painful condition where infected gums swell, ulcerate, and slough off dead tissue.
In the case of dental implants, peri-implant disease occurs where bacteria can cause irritation, inflammation, and destruction of the surrounding gum and bone, much in the same way that periodontal disease affects the surrounding structures of teeth.
It is possible to have gingivitis or periodontitis and not notice any signs or symptoms. Hence, regular visits to a dental professional are vital in determining a patient's specific risk level.
The dentist is the primary care provider for the mouth and will be able to provide all of the facts and information necessary in diagnosing the disease and taking steps in treating gum disease.
How is gum disease diagnosed?
The following methods and symptoms and signs are instrumental in the diagnosis of gum disease during routine check-ups:
Measuring the gums: A dentist or dental hygienist will use a periodontal probe to measure the depths of the pockets around the teeth in the mouth, generally once per calendar year. Healthy gums will have pockets one mm-3 mm deep. Beyond that, the deeper the pockets, the more severe the disease.
Taking X-rays: Dental X-rays, particularly bitewing X-rays, will help show the level of the underlying bone and whether any bone has been lost to periodontal disease.
Examining sensitive teeth: Teeth that have become sensitive around the gum line may indicate areas of receding gums.
Checking for loose teeth: Teeth may become loose due to bone loss or an incorrect bite.
Checking the gums: A dentist or hygienist will look for red, swollen, or bleeding gums.
What is the treatment for gum disease?
The treatment goals for gingivitis are to identify and eliminate the factors that make the person more susceptible to gum disease. Most factors can be eliminated by establishing more consistent and thorough oral hygiene habits and professional dental cleanings. Suppose certain risk factors such as smoking or uncontrolled diabetes contribute to gum disease. In that case, they need to be addressed or eliminated to reverse gingivitis successfully.
Cleaning, brushing, and flossing
After the plaque and tartar are removed by a dentist or dental hygienist, the patient can usually eliminate gingivitis by brushing and flossing after every meal.
Prescription mouth rinses
Under the supervision of a dentist, a patient can use a prescription mouth rinse that specifically targets oral bacteria that cause gum disease. This is especially helpful in patients with impaired conventional oral hygiene practices like brushing and flossing due to age or special needs.
Scaling and root planing
In individuals where gingivitis has led to periodontal disease and deep pockets that are difficult to clean, the patient may require deep scaling and root planing to clean teeth surrounded by deep pockets. They may need surgical treatment to gain access to all the tooth surfaces for a more thorough cleaning:
This surgical procedure is called flap surgery and can be combined with pocket-reduction surgery to make the areas around the teeth more accessible for the patient to clean with brushing and flossing.
This procedure consists of numbing the gums and then lifting them back to expose and clean the teeth and sometimes reshaping the bone.
The gums are then repositioned back around the teeth, so there aren't the deep pockets that existed before treatment.
Soft-tissue grafts
Soft-tissue grafts covers uproot surfaces exposed by receding gums. This can help eliminate sensitive teeth and protect the root surfaces that are softer and more difficult to clean.
Laser therapy
Laser therapy is another treatment to help increase gum health. The gum pocket is treated with a soft-tissue laser to eliminate the harmful bacteria deep in the periodontal pockets, remove unhealthy tissue, and help stimulate healing.
What types of specialists treat gum disease?
Periodontists are dentists who have completed additional training in periodontology after dental school. They are focused entirely on evaluating, diagnosing, and treating the disease of the gum and bone surrounding the teeth.
In advanced cases of gingivitis or periodontitis, a general dentist may recommend a gross debridement of superficial plaque and tartar and then refer the affected patient to a periodontist for evaluation. Periodontists may recommend various nonsurgical or surgical procedures to help stabilize the gum condition.
Periodontists are also very skilled at performing treatments of other conditions of the gums and bone, including gum and bone grafts, functional and esthetic gingivectomy, gingivoplasty, implants, and crown lengthening. Because gum disease in its advanced stages is the primary cause of tooth loss today, periodontists are especially important in working to treat complex diseases.
What types of medications are used to treat gum disease?
Medications to treat gum disease may include:
Chlorhexidine gluconate (Peridex) is an antiseptic mouthwash that can be used under the direction of a dentist to help reduce the bacteria that cause gum disease.
Additionally, antibiotic therapy can be combined to help treat periodontitis.
Pellets or gels like PerioChip that contain chlorhexidine or doxycycline can be placed in deep gum pockets after deep scaling and root planning to kill stubborn bacteria and reduce the size of periodontal pockets. These modes of delivering medications are very effective because the agent is released slowly over about seven days.
Additional medications such as Xylocaine and NSAIDs may be needed for pain control during and after treatment.
Are home remedies or natural treatments effective for gum disease?
There has been evidence to suggest the effectiveness of the following over-the-counter and natural treatments for gum disease:
Green tea has antioxidants that reduce inflammation in the body.
Hydrogen peroxide helps kill bacteria when used as a mouthwash or gel in a custom-fitted tray, but it cannot be swallowed.
Warm salt water rinses can help to soothe sore mouth tissue.
Baking soda diluted in water can be used to rinse and brush the teeth and gum line to help neutralize the acids that irritate the gum tissue.
In addition, see the section on preventing gum disease and toothpaste.
Is it possible to reverse gum disease?
As long as the causes of early-stage gum disease (gingivitis) are correctly identified, and the patient is persistent in improving their oral hygiene and seeking necessary treatment, gum disease can be reversible.
The prognosis is best when treatment is obtained in the early stages of gingivitis. At this stage, the affected person usually needs a professional dental cleaning and more thorough brushing and flossing to reverse the disease.
Once the bacteria spread to the bones in periodontitis, irreversible changes can start with a loss of attachment of the gums and bone loss. Therefore, catching and treating gum disease is crucial as early as possible.
Is gum disease associated with other health problems?
There have been many attempts to understand the link between gum disease and other systemic health problems such as heart disease, stroke, and Alzheimer's disease. Comparing the bacteria that cause dental plaque with the bacteria involved in heart disease suggests a correlation between gum disease and heart disease. Still, researchers have been unable to establish a cause-and-effect relationship.
According to the American Academy of Periodontology, recent studies have shown that periodontal disease bacteria may play a role in the pathology of Alzheimer's disease. These relationships are difficult to prove or disprove, so it is fair to assume that aiming for a life free of gum disease will only help lead a generally healthier life.
While it may be hard to prove what health problems are directly caused by gum disease, it is known that specific health problems can cause gum disease. If there are any sudden changes to a person's medical condition, they should ask their primary care provider or dentist if there might be any effects on oral health. Healthy gums can quickly become threatened when the body's overall health diminishes or changes.
How is gum disease managed in children?
A child should start having their teeth brushed with a pea-sized amount of toothpaste beginning at 12 months of age. Emphasis should be placed on brushing all surfaces of the teeth, including the gum line.
As soon as the gaps between the teeth start to close, it is important to start flossing. In the beginning, the parents should establish a routine to brush the teeth so the child can get used to it. As soon as the child is able, the brushing and flossing should be passed over to them and monitored by the parent to ensure good thorough technique and consistency.
According to the American Dental Association, a child should get regular dental visits starting at about one year. Abiding by these guidelines will help prevent and treat gum disease in most children.
It is common for an increase in gingivitis during puberty due to the hormonal changes that occur throughout the body. Adolescents should be monitored for good oral hygiene habits and taken to the dentist regularly to treat gum disease with professional dental cleanings.
How is gum disease managed in pregnancy?
Many pregnant women think that they should avoid the dentist to keep their pregnancy safe, but they shouldn't miss their professional cleanings as long as they feel strong and comfortable enough.
During pregnancy, women are at risk of developing pregnancy gingivitis. Because of the increase in hormones that occurs with pregnancy, the gum tissues are more susceptible to attack from bacteria and other pathogens. Pregnant women will often notice increased swelling and bleeding gums even if their oral hygiene has remained consistent. It may be necessary to get dental cleanings more often than usual during pregnancy to help combat this increased risk.
Is it possible to prevent gum disease?
Prevention of gingivitis and periodontitis is effortless in most cases. Gum disease is best prevented through proper plaque control. This involves brushing to remove plaque from the outer surfaces of the teeth and flossing to remove food particles and plaque from in between the teeth.
Electronic toothbrushes tend to make it easier to remove plaque from some of the harder-to-reach areas of the mouth. Using a mouthwash after brushing and flossing can also help reduce the bacteria that cause gingivitis.
Besides these basic oral hygiene practices, other things can be done to eliminate the factors that lead to an increase in gum disease:
Sleep/Stress: The immune system is essential in controlling disease, and getting adequate sleep and reducing stress will help the body fight gum disease.
Stop smoking: Smokers are much more likely to develop gingivitis and periodontitis. Avoiding tobacco should be a primary goal to achieve healthy gums.
Orthodontic therapy or braces: It is much easier to remove straight teeth than from crowded, overlapped, and crooked teeth. Braces can make a big difference in having healthier gums.
Diet: Limiting the frequency of plaque-causing sugars and carbohydrates will help limit plaque. Eating a well-balanced diet will help keep the body's immune system healthy and ready to fight infection.
What is the best toothpaste to use to prevent gum disease?
The goal of tooth brushing is to remove plaque on the teeth that will harbor bacteria and cause gum disease and tooth decay. When used with consistent, thorough brushing habits, just about any toothpaste will accomplish this goal. There are other ingredients in toothpaste that help remove plaque more effectively and help keep plaque off the teeth after they have been brushed.
Fluoride in toothpaste, particularly stannous fluoride, helps to kill mouth bacteria.
The abrasive agents in toothpaste, such as silicates and calcium carbonates, help remove sticky plaque.
Sodium sulfate (SLS) is a detergent in toothpaste that causes the foaming effect of toothpaste. Toothpaste varies in the amount of SLS they contain; a high concentration of SLS can cause problems for patients who have dry mouth or low saliva flow.
Some toothpaste includes plaque-control agents such as pyrophosphates and zinc citrate that prevent plaque from sticking to the teeth after they've been brushed.
Using toothpaste that contains any combination of these ingredients will increase the effectiveness of oral hygiene.
You can always get in touch with the team at Dr. Kumarswamy’s Perio Family to maintain healthy gums. Visit Dr. Kumarswamy's Perio Family Dental clinic regularly to attain excellent oral hygiene and ensure your teeth last for life.
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