What Is Gingivitis? What Causes Gingivitis?

*What Is Gingivitis? What Causes Gingivitis? 
 Before and After: (Top picture) Severe gingivitis before treatment.  (Bottom picture) After mechanical debridement of teeth and surrounding gum tissues

 Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of bacteria that accumulate on the teeth - plaque; this type is called plaque-induced gingivitis. Gingivitis is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.  A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. Generally, gingivitis resolves with good oral hygiene - longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.

In mild cases of gingivitis, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately.

What are the signs and symptoms of gingivitis?

A symptom is something the patient feels and describes, such as painful gums, while a sign is something everybody, including the doctor or nurse can see, such as swelling.

In mild cases of gingivitis there may be no discomfort or noticeable symptoms.

Signs and symptoms of gingivitis may include:

• Gums are bright red or purple
• Gums are tender, and sometimes painful to the touch
• Gums bleed easily when brushing teeth or flossing
• Halitosis (bad breath)
• Inflammation (swollen gums)
• Receding gums
• Soft gums

What are the causes of gingivitis?

The accumulation of plaque and tartar

The most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth, which triggers an immune response, which in turn can eventually lead to the destruction of gingival tissue, and eventually further complications, including the loss of teeth.

Dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonizing bacteria that are trying to stick to the smooth surface of a tooth. Some experts say that they might help protect the mouth from the colonization of harmful microorganisms. However, dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis.

When plaque is not removed adequately, it causes an accumulation of calculus (tartar - it has a yellow color) at the base of the teeth, near the gums. Calculus is harder to remove, and can only be removed professionally.

Plaque and tartar eventually irritate the gums.

Gingivitis may also have other causes, including:

• Changes in hormones - which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva may become more sensitive, raising the risk of inflammation.
• Some diseases - such as cancer, diabetes, and HIV are linked to a higher risk of developing gingivitis.
• Drugs - oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin (anticonvulsant), and some anti-angina medications may also cause abnormal growth of gum tissue.
• Smoking - regular smokers more commonly develop gingivitis compared to non-smokers.
• Family history - experts say that people whose parent(s) has/had gingivitis, have a higher risk of developing it themselves.

Diagnosing gingivitis

A dentist or oral hygienist checks for gingivitis symptoms, such as plaque and tartar in the oral cavity.

Checking for signs of periodontitis may also be recommended; this may be done by X-ray or periodontal probing.

What are the treatment options for gingivitis?

If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home.

Gingivitis care with a dental professional:

• Plaque and tartar are removed. This is known as scaling. Some patients may find scaling uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
• The dental professional explains to the patient the importance of oral hygiene, and how to effectively brush his/her teeth, as well as flossing
• Periodically following-up on the patient, with further cleaning if necessary
• Fixing teeth so that oral hygiene can be done effectively. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar (they may also irritate the gums).

What the patient can do at home:

• Brush your teeth at least twice a day
• Bear in mind that in most cases, electric toothbrushes do a better job than we can do on our own
• Floss your teeth at least once a day
• Regularly rinse your mouth with an antiseptic mouthwash. Ask your dentist to recommend one.

What are the possible complications from gingivitis?

In the vast majority of cases, if gingivitis is treated and the patient follows the dental health professional's instructions, there are no complications. However, if the condition is left untreated, gum disease can spread and affect tissue, teeth and bones, leading to periodontitis.

Possible complications from gingivitis may include:

• Abscess in the gingiva
• Abscess in the jaw bones
• Infection in the jaw bone or gingiva
• Periodontitis - this is a more serious condition that can lead to loss of teeth
• Recurrent gingivitis
• Trench mouth - ulceration of the gums caused by bacterial infection

Several studies have linked gum diseases, such as periodontitis, to cardiovascular diseases, including heart attack or stroke. Other reports have found an association with lung disease risk.

*Source: Nordqvist      , C. (2012, February 15). "What Is Gingivitis? What Causes Gingivitis?." Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/241721.php.

Oral health: Why is it so important?

Oral health is defined as the health of all oral structures and while the usual focus lies on teeth, it is important to not neglect other oral structures such as the lips, tongue, inside lining of the mouth, roof of mouth or palate, soft palate, throat, and tonsils. Periodontal health should also be taken into consideration, as they are the supporting structures of the teeth which is crucial for adequate retention of teeth. All these play an important role in the functioning of the mouth hence need to be maintained at a satisfactory level in order to prevent problems.

The public perception of oral health

Oral health has been an important focus in recent years due to the shift for better smile and healthier lifestyle. Peer pressure force people to maintain their mouths at a socially acceptable standard and depending on the group, these ‘standards’ are very subjective and may have great variations inter-group. Some people may place an important focus on simply being able to function with their mouths while others may have greater emphasis on the appearance and impressions they give of their mouths. Besides social background, other factors such as employment can also influence their perception towards oral health. For example an individual who has never been concerned about the appearance of their smile may start becoming self conscious of their poor oral health if they landed work in public relations or similar jobs that requires professional level of client interactions.

Why is it so important to maintain good oral health? Good oral health is as important as it is in direct relationship with function and the state of its health influences our ability to perform such tasks with our mouths. These include speaking, eating, swallowing, smiling and others. Deterioration of oral health will cause impairment in at least one of those areas. The impact of this, again can be subjective depending on the individual perception towards the importance of affected function.  There is a close link between oral and general health, which cannot be refuted. Sudden oral health deterioration in individuals practicing reasonable oral hygiene can often be the first signs of underlying systemic diseases. Very often, oral changes precede medical diagnosis and the mouth is usually the first to show signs of the disease. This is especially true for conditions that affect the immune system such as diabetes and leukemia. This is because impaired healing is frequently reflected in the mouth where even the tiniest amount of plaque can cause significant gum diseases due to exaggerated inflammatory response. Such oral manifestations are hard to treat and usually behave aggressively until the underlying condition is managed. There have also been numerous evidences suggesting the link between poor periodontal health and cardiovascular diseases where the bacterium involved in periodontal diseases can be found on the plaque lining of affected blood vessels. Recent study has also shown people with poorer oral health tend to have higher mortality rates and greater risks of acquiring cardiovascular diseases than their healthier counterparts who have more teeth.  Oral health being able to influence our daily functioning and general health plays a key factor behind our social health. Most people fail to recognize this important relationship which leads to poor care of oral health. Being able to masticate and swallow properly is a form of basic need which is important to all of us. The ability to speak properly and smile comfortably is a form of interaction that molds our social life. Impairment of this can often lead to isolation and poor self esteem, sometimes causing more significant problems such as depression. Other aspects such as simply being in a pain free state is also crucial as toothaches are often rated highly when it comes to people’s inability to tolerate pain. It often creates more disturbance to daily life and affects people’s ability to work more so than other common sickness such as fever or cold.

Source: intelligentdental.com

FLOSSING BASICS

The American Dental Association advises that flossing your teeth thoroughly be done once or more per day. Overly vigorous or incorrect flossing can result in damage to the gum tissues therefore this article will provide some basics on flossing.

What is flossing?

Dental floss is made of either a bundle of thin nylon filaments or a plastic that is indicated for plaque and debris removal in areas where teeth contact with each other. The floss is gently inserted between the teeth and scraped along the teeth sides, especially close to the gums. An alternative tool to achieve the same effect is the interdental brush, which is more helpful in areas where the gums have receded in between the teeth.  The two frequently used dental flossing methods are the spool method and the circle, or loop, method. Control of the floss and ease of handling can be seen in both methods.  Flossing of teeth is a complex skill, so until children develop adequate dexterity (which is usually around the age of 10 to 12 years), an adult should perform flossing on the child. Younger children whose teeth still exhibit primate spaces (where there is no contact between adjacent teeth) will not require flossing.

The spool method

The spool method is particularly suited for teenagers and adults who have acquired the necessary coordination required to use floss. When using the spool method, a piece of floss approximately 18 inches long is used. The bulk of the floss is lightly wound around the middle finger. Space should be left between wraps to avoid impairing circulation to the fingers. The rest of the floss is similarly wound around the same finger of the opposite hand. This finger can wind, or “take up,” the floss as it becomes soiled or frayed to permit access to an unused portion. The last three fingers are clenched and the hands are moved apart, pulling the floss taut, thus leaving the thumb and index finger of each hand free. The floss is then secured with the index finger and thumb of each hand by grasping a section three quarters to 1 inch long between the hands.

The loop method

The loop method is suited for children as well as adults with less nimble hands or physical limitations caused by conditions such as poor muscular coordination or arthritis. For the loop method, the ends of the 18-inch piece of floss are tied in a knot. All of the fingers, but not the thumbs of the two hands are placed close to one another within the loop. Whether using the spool or the loop method of flossing, the same basic procedures are followed. The thumb and index finger of each hand are used in various combinations to guide the floss between the teeth.  When inserting, floss, it is gently eased between the teeth with a seesaw motion at the contact point. The gentle seesaw motion flattens the floss, making it possible to ease through the contact point and prevent snapping it through, thus avoiding trauma to the gums in between the teeth. Once past the contact point between teeth, the floss is adapted to each approximating surface by creating a C-shape. The floss is then directed downwards towards the gumline and back to the contact area (up-and-down against the side of the tooth) several times or until the tooth surface is clean. The procedure is repeated on the adjacent tooth in the proximal area, using care to prevent damage to the gums in between while readapting to the adjacent tooth. A clean, unused portion should be used for each area between teeth. 

In general, Teeth flossing is best performed by cleaning each tooth in succession, including the back surface of the last tooth in each quadrant. Incorrect flossing can often be detected through observation of the gums and the technique. Signs that suggest incorrect use of dental floss include cuts on the gums, bleeding gums, indentation on the soft tissues of the mouth, and wear on tooth surfaces and gumline. If flossing trauma is evident, further instruction should be given until the individual has become adept. Proper instruction and practice allows most motivated adults to master either the spool or loop method of flossing. In certain circumstances, the use of a floss holder, floss threader, variable-thickness floss, or pre-cut floss strands with a stiff end may be more effective.

It is important to note that a flossing habit has traditionally been difficult for people to embrace. In reality, only a very small proportion of individuals practice daily flossing. Floss may be superior to other interproximal (the area between teeth) cleaning methods, but for those who have not or will not adopt a flossing behavior another interproximal device may be more effective than no interproximal cleaning. A less effective device used on a regular basis is superior to irregular use of a more effective device.
(Source: http://www.intelligentdental.com)

Periodontitis (advanced gum disease)

What is gum disease?

Gum disease is an infection of the tissues and bones that surround and support the teeth. It is also called periodontal disease. 

The two stages of gum disease are called gingivitis and periodontitis. Gingivitis is mild gum disease that affects only the gums, the tissue that surrounds the teeth. Periodontitis is gum disease that gets worse and spreads below the gums to damage the tissues and bone that support the teeth.

• Gingivitis causes red, swollen gums that bleed easily when the teeth are brushed. Because gingivitis usually doesn't cause pain, many people don't get the treatment they need.
• Periodontitis develops if gum disease gets worse. The gums pull away from the teeth, leaving deep pockets where germs called bacteria can grow and damage the bone that supports the teeth. Gums can also shrink back from the teeth. This can make the teeth look longer. Teeth may become loose, fall out, or have to be pulled out by a dentist.

What causes gum disease?

Your mouth constantly makes a clear, sticky substance called plque that contains bacteria. The bacteria in plaque make poisons, or toxins, that irritate the gums and cause the gum tissues to break down. If you don't do a good job of removing plaque from your teeth, it can spread below the gums and damage the bone that supports the teeth. With time, the plaque hardens into a substance called tartar that has to be removed by a dentist or dental hygienist.

You are more likely to get gum disease if you:

• Do not clean your teeth well.
• Smoke or chew tobacco.
• Have someone in your family who has gum disease.
• Have a condition that makes it harder for your body to fight infection, such as:
• Uncontrolled  diabetes, AIDS, or leukemia.
• A high level of stress.
• A poor diet that’s low in nutrients.

What are the symptoms?

It may be hard to tell if you have a mild case of gum disease. Healthy gums are pink and firm, fit snugly around the teeth, and do not bleed easily. But mild cases of gum disease (gingivitis) cause:

• Gums that are red, swollen, and tender.
• Gums that bleed easily during brushing or flossing.

As gum disease gets worse (periodontitis), the symptoms are easier to see, such as:

• Gums that pull away or shrink from the teeth.
• Bad breath that won't go away.
• Pus coming from the gums.
• A change in how your teeth fit together when you bite.
• Loose teeth.

How is gum disease diagnosed?

To find out if you have gum disease, your dentist will do an exam to look for:

• Bleeding gums.
• Hard buildups of plaque and tartar above and below the gums.
• Areas where your gums are pulling away or shrinking from your teeth.
• Pockets that have grown between your teeth and gums.

Your dentist or dental hygienist may take X-rays of your teeth to look for bone damage and other problems.

How is it treated?

If you have a mild case of gum disease, you will probably be able to take care of it by brushing and flossing your teeth every day and getting regular cleanings at your dentist's office.

If your gum disease has become worse and you have periodontitis, your dentist or dental hygienist will clean your teeth using a method called root planing and scaling. This removes the plaque and tartar buildup both above and below the gum line.  If your gum disease is severe, you may need to have surgery.

How can you prevent gum disease?

Gum disease is most common in adults, but it can affect anyone, even children. These good dental habits are important throughout your life:

• Brush your teeth at least 2 times a day, in the morning and before bedtime, with a fluoride toothpaste.
• Floss your teeth at least once each day.
• Visit your dentist for regular checkups and teeth cleaning.
• Don't use tobacco products.

If you think you have a mild case of gum disease, make sure to take care of it before it gets worse. Keeping your teeth and gums healthy and getting regular checkups can keep the disease from getting worse.  Dr. Faddis and his team of Hygienists perform a thorough periodontal screening on every patient, at every routine visit. Call our office to schedule your visit today. We will review with you the findings and explain any concerns or treatment that might be needed.