Gingivitis
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Gingivitis is the inflammation of the gums (gingiva) around the teeth. Gingivitis may be caused by a build up of plaque and tartar due to improper cleaning of teeth, or by injury to the gums from over-vigorous brushing. The condition is generally reversible. Brushing teeth thoroughly, but gently, with toothpaste and flossing with dental floss are the best ways to prevent gingivitis.
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[edit] Causes
Gingivitis is usually caused by bacterial plaque that accumulates in the spaces between the gums and the teeth and in calculus (tartar) that forms on the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce foreign chemicals and toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause deep pockets between the teeth and gums and loss of bone around teeth otherwise known as periodontitis. Since the bone in the jaws holds the teeth into the jaws, the loss of bone can cause teeth over the years to become loose and eventually to fall out. Regular cleanings (correctly termed periodontal debridement, scaling or root planing) below the gum line, best accomplished professionally by a dental hygienist or dentist, disrupt this plaque biofilm and remove plaque retentive calculus (tartar) to help prevent inflammation. Once cleaned, it takes 3-4 months for the bacteria and plaque to grow back and once again restart the inflammation process. Calculus may start to reform within 24 hours. Ideally, scientific studies show that all people with deep periodontal pockets (greater than 5mm) should have their gums cleaned by a dental hygienist or dentist every 3-4 months. People with a healthy periodontium (gums, bone and ligament) or people with gingivitis only require periodontal debridement every 6 months. However, many dental professionals only recommend periodontal debridement (cleanings) every 6 months, because this has been the standard advice for decades, and because the benefits of regular periodontal debridement (cleanings) are too subtle for many patients to notice without regular education from the dental hygienist or dentist. If the inflammation in the gums becomes especially well-developed, it can invade the gums and allow tiny amounts of bacteria and bacterial toxins to enter the bloodstream. The patient may not be able to notice this, but studies suggest this can result in a generalized increase in inflammation in the body cause possible long term heart problems. Periodotitis has also been linked to diabetes, arterosclerosis, osteoporosis and pre-term low birth weight babies.
Sometimes, the inflammation of the gingiva can suddenly amplify, such as to cause a disease called Acute Necrotizing Ulcerative Gingitivitis (ANUG), otherwise known as "trench mouth." The etiology to ANUG is the overgrowth of a particular type of pathogenic bacteria but risk factors such as stress, poor nutition and a compromised immune system can exacerbate the infection. This results in the breath being extremely bad-smelling, and the gums feeling considerable pain and degeration of the periodontium rapidly occurs. Fortunately, this can be cured with a 1-week dose of Metronidazole antibiotic, followed by a deep cleaning of the gums by a dental hygienist or dentist and reduction of risk factors such as stress.
When the teeth are not cleaned properly by regular brushing and flossing, bacterial plaque accumulates, and becomes mineralized by calcium and other minerals in the saliva transforming it into a hard material called calculus (tartar) which harbors bacteria and irritates the gingiva (gums). Also, as the bacterial plaque biofilm becomes thicker this creates and anoxygenic environment which allows more pathogenic bacteria to flourish and release Toxins and cause gingival inflammation. Alternatively, excessive injury to the gums caused by very vigorous brushing may lead to recession, inflammation and infection. Pregnancy, uncontrolled diabetes mellitus and the onset of puberty increase the risk of gingivitis, due to hormonal changes that may increase the susceptibility of the gums or alter the composition of the dentogingival microflora. The risk of gingivitis is increased by misaligned teeth, the rough edges of fillings, and ill fitting or unclean dentures, bridges, and crowns. This is due to their plaque retentive properties. The drug phenytoin, birth control pills, and ingestion of heavy metals such as lead and bismuth may also cause gingivitis. The sudden onset of gingivitis in a normal, healthy person should be considered an alert to the possibility of an underlying viral aetiology, although most systemically healthy individuals have gingivitis in some area of their mouth, usually due to inadequate brushing and flossing.
[edit] Symptoms
The symptoms of gingivitis are as follows:
- Swollen gums
- Mouth sores
- Bright-red, or purple gums
- Shiny gums
- Gums that are painless, except when touched
- Gums that bleed easily, even with gentle brushing
- Gums that itch with varying degrees of severity
- Receding gumline
[edit] Prevention
Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing.
[edit] Diagnosis
It is recommended that a dental hygienist or dentist be seen after the signs of gingivitis appear. A dental hygineist or dentist will check for the symptoms of gingivitis, and may also examine the amount of plaque in the oral cavity. A dental hygienist dentist should also test for periodontitis using X-rays or gingival probing as well as other methods.
[edit] Treatment
A dentist or dental hygienist will perform a thorough cleaning of the teeth and gums. Following that, persistent oral hygiene is necessary. The removal of plaque and calculus is usually not painful, and the inflammation of the gums should be gone between one and two weeks. Oral hygiene including proper brushing and flossing is required to prevent the recurrence of gingivitis. Anti-bacterial rinses or mouthwash may reduce the swelling and local mouth gels which are usually antiseptic and anaesthetic can also help.
[edit] Complications
- Recurrence of gingivitis
- Periodontitis
- Infection or abscess of the gingiva or the jaw bones
- Trench mouth (bacterial infection and ulceration of the gums)
