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.
Gingivitis is “Inflammation of the gingiva as a response to bacterial plaque on adjacent teeth; characterized by erythema, edema, and fibrous enlargement of the gingiva without resorption of the underlying alveolar bone.”
(Top) Severe gingivitis before treatment.
(Bottom) After mechanical debridement of teeth and surrounding gum tissues
There are two main categories of gingival diseases
Dental plaque-induced gingival disease
Gingivitis caused only by plaque
Gingivitis caused by systemic factors
Gingivitis caused by medications
Gingivitis caused by malnutrition
- Non-plaque induced gingival lesions
Gingival diseases – caused by a specific bacterium
Gingival diseases – caused by a specific virus
Gingival diseases – caused by a specific fungus
Gingival diseases – caused by genetic factors
Gum inflammations caused by systemic conditions
Gum inflammations caused by traumatic lesions
Gum inflammations caused by reactions to foreign bodies
Gum inflammations without known causes
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 HIVare 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.
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
Written by Christian Nordqvist
Copyright: Medical News Today
Tooth Scaling May Lower Heart Risk While Gum Disease
Predicts Type Of Risk
Two new studies give further insights into the links between mouth hygiene, gum disease and cardiovascular events. Researchers found that dental patients who had their teeth cleaned and scaled professionally had reduced risks of heart attack and stroke, while researchers in Sweden find that the type of periodontal or gum disease may predict degree of risks for heart attack, stroke and heart failure
Both studies are presented this week at the American Heart Association’s (AHA’s).
In their nationwide, population-based study, Drs Emily (Zu-Yin) Chen and Hsin-Bang Leu from the Cardiology department at Taipei Veterans General Hospital, examined data on over 51,000 adults who had received at least one full or partial tooth scaling from a dentist or dental hygienist, and a similar number of matched controls who had never had their teeth professionally cleaned.
None of the participants had a history of stroke or heart attack. The data came from Taiwan National Health insurance records, and the researchers ran statistical tests to compare the cardiovascular event rates between the two groups for an average follow- up of seven years.
They found that participants who had their teeth professionally scaled frequently or occasionally had a 24% lower risk of heart attack and a 13% lower risk of stroke compared to those who did not. The researchers considered tooth scaling frequent if it occurred at least twice or more in two years, and considered it occasional if it happened once or less in two years.
Chen, a cardiology fellow at Taipei Veterans General Hospital, told the press:
“Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year.”
She suggested that professional tooth scaling removes inflammation-causing bacteria that in turn can lead to heart disease and stroke.
One drawback of the study is that the researchers did not adjust the results to take into account other potential risk factors for cardiovascular disease, such as weight, smoking and race, since this information wasn’t in the health records.
The Swedish study was the work of Dr Anders Holmlund of the Centre for Research and Development of the County Council of Gävleborg, and senior consultant, Specialized Dentistry, and Dr Lars from the Department of Acute Medicine at Uppsala Academic Hospital.
They examined data on 7,999 participants with periodontal or gum disease and found that types of gum disease predict risk for heart attack, congestive heart failure and stroke in different ways and to different degrees.
Afer adjusting for age, gender, smoking and education level, their results showed that:
- Participants who had fewer than 21 teeth had a 69% higher risk of heart attack compared to those who had the most teeth.
- Participants with most infection (ie the highest number of deepended periodontal pockets around the base of the teeth) had a 53% higher risk of heart attack compared to those with the least infection (fewest number of pockets).
- The participants with the fewest number of teeth had 2.5 times the risk of congestive heart failure compared to those with the most teeth.
- Those with the highest incidence of gum bleeding had 2.1 times the risk of stroke compared to participants with the lowest incidence.
Holmlund and Lars concluded that:
“Markers of periodontal disease predict future common cardiovascular events in different ways, suggesting that they are risk indicators for different cardiovascular disorders.”
Written by Catharine Paddock PhD
Your body is like a complex machine. The foods you choose as fuel and how often you “fill up” affect your general health and that of your teeth and gums. Many dentists are concerned that their patients are consuming record numbers of sugar-filled sodas, sweetened fruit drinks, and non-nutritious snacks that affect their teeth. These items generally have little if any nutritional value and over time they can take a toll on teeth.
Eating patterns and food choices among children and teens are important factors that affect how quickly youngsters may develop tooth decay. When bacteria (plaque) come into contact with sugar in the mouth, acid is produced, which attacks the teeth for 20 minutes or more. This can eventually result in tooth decay.
The government’s recommendations recognize that people have different dietary needs at various stages of life. They offer guidance for children and adults based on their levels of physical activity. Your physician or a registered dietician can also provide suggestions for your daily food intake.
Foods that contain sugars of any kind can contribute to tooth decay. Almost all foods, including milk or vegetables, have some type of sugar. However, they shouldn’t be removed from our diets because many of them contain important nutrients. And they add pleasure to eating. To help control the amount of sugar you consume, read food labels and choose foods and beverages that are low in added sugars. Added sugars often are present in soft drinks, candy, cookies and pastries.
If your diet lacks certain nutrients, it may be more difficult for tissues in your mouth to resist infection. This may contribute to periodontal (gum) disease, a major cause of tooth loss in adults. Although poor nutrition does not cause periodontal disease directly, many researchers believe that the disease progresses faster and could be more severe in people with nutrient-poor diets
What can you do?
- Maintain a healthy diet.
- Make sure water is readily available.
- Limit the number of between-meal snacks. When you must snack, choose nutritious foods that are low in sugar.
- Brush thoroughly twice a day with a fluoride toothpaste.
- Floss or use another kind of interdental cleaner daily to remove plaque (a thin film of bacteria) from under the gums and between teeth.
- Schedule regular dental visits for checkups and cleanings.
- Keep a food diary for a week. Record every item you eat and drink, including hard candies or chewing gum that contains sugar. Compare the diary to the food Pyramid recommendations.
When you eat, food passes through your mouth. Here it meets the germs, or bacteria, that live in your mouth. You may have heard your dentist talk about plaque. Plaque is a sticky film of bacteria.
These bacteria love sugars found in many foods. When you don’t clean your teeth after eating, plaque bacteria use the sugar to produce acids that can destroy the hard surface of the tooth, called enamel. After a while, tooth decay occurs. The more often you eat and the longer foods are in your mouth, the more damage occurs.
Some foods that you would least expect contain sugars. Some examples are fruits, milk, bread, cereals and even vegetables.
The key to choosing foods wisely is not to avoid these foods, but to think before you eat. Not only what you eat but when you eat makes a big difference in your dental health. Eat a balanced diet and limit between-meal snacks. If you are on a special diet, keep your physician’s advice in mind when choosing foods. For good dental health, keep these tips in mind when choosing your meals and snacks.
- To get a balanced diet, eat a variety of foods. Choose foods from each of the five major food groups:
- breads, cereals and other grain products
- meat, poultry and fish
- milk, cheese and yogurt
- Limit the number of snacks that you eat. Each time you eat food that contains sugars, the teeth are attacked by acids for 20 minutes or more.
- If you do snack, choose nutritious foods, such as cheese, raw vegetables, plain yogurt, or a piece of fruit.
- Foods that are eaten as part of a meal cause less harm. More saliva is released during a meal, which helps wash foods from the mouth and helps lessen the effects of acids.
- Brush twice a day with a fluoride toothpaste.
- Clean between your teeth daily with floss or interdental cleaners.
- Visit your dentist regularly. Your dentist can help prevent problems from occurring and catch those that do occur while they are easy to treat.
There are many factors that affect whether decay forms. What we do know is that when teeth come in frequent contact with soft drinks and other sugar-containing substances, the risk of decay formation is increased. The Association seeks to educate the public about ways to decrease disease risk.
Choose beverages that hydrate and contribute to good nutrition. Drinking 8-12 cups of water a day is important and consuming optimally fluoridated water can help prevent tooth decay.