gingivitis

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Gingivitis ("inflammation of the gums") around the teeth is a general term for gingival diseases affecting the gingiva (gums).^[1] As generally used, the term gingivitis refers to gingival inflammation induced by bacterial biofilms (also called plaque) adherent to tooth surfaces.

Causes

Gingivitis can be defined as inflammation of the gingival tissue without loss of tooth attachment (i.e.periodontal ligament). Gingivitis is an irritation of the gums. It is usually caused by bacterial plaque that accumulates in the small gaps between the gums and the teeth and by 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—an effect otherwise known as periodontitis. Since the bone in the jaws holds the teeth into the jaws, the loss of bone from periodontitis can cause teeth over the years to become loose and eventually to fall out or need to be extracted because of acute infection.

Proper maintenance (varying from "regular cleanings" to periodontal maintenance or scaling and root planing) above and below the gum line, done professionally by a dental hygienist or dentist, disrupts this plaque biofilm and removes plaque retentive calculus (tartar) to help remove the etiology of inflammation. Once cleaned, plaque will begin to grow on the teeth within hours. However, it takes approximately 3 months for the pathogenic type of bacteria (typically gram negative anaerobes and spirochetes) to grow back into deep pockets and restart the inflammatory process. Calculus (tartar) may start to reform within 24 hours. Ideally, scientific studies show that all people with deep periodontal pockets (greater than 5 mm) should have the pockets between their teeth and gums cleaned by a dental hygienist or dentist every 3–4 months.

People with a healthy periodontium (gingiva, alveolar bone and periodontal ligaments) or people with gingivitis may only require periodontal debridement every 6 months. However, many dental professionals only recommend debridement (cleanings) every 6 months, because this has been the standard advice for decades, and because the benefits of regular 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 and/or cause possible long term heart problems. Periodontitis has also been linked to diabetes, arteriosclerosis, osteoporosis, pancreatic cancer and pre-term low birth weight babies.^{[citation needed]}

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 of ANUG is the overgrowth of a particular type of pathogenic bacteria (fusiform-spirochete variety) but risk factors such as stress, poor nutrition 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 degeneration of the periodontium rapidly occurs. This can be successfully treated with a 1-week course 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 an anoxygenic environment which allows more pathogenic bacteria to flourish and release toxins and cause gingival inflammation. 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.^{[citation needed]} 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. Birth control pills, and ingestion of heavy metals such as lead and bismuth may also cause gingivitis.^{[citation needed]}

Symptoms

The symptoms of gingivitis are as follows:^{[citation needed]}

• Swollen gums
• Mouth sores
• Bright-red, or purple gums
• Shiny gums
• Swollen gums that emit pus
• Severe oral odor
• Gums that are tender, or painful to the touch.
• Gums that bleed easily, even with gentle brushing, and especially when flossing.
• Gum Pockets
• Bad Breath

Treatment

• Metronidazole
• Antiseptic Mouthwash
• Floss
• Hydrogen Peroxide Rinse
• Gum Surgery
• Cleaning
• Curettage
• ProxaBrush

Prevention

OTC anti-gingivitis mouthwash containing chlorhexidine from Mexico.

Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing. Mouthwash or Hydrogen Peroxide can be helpful, usually using peroxide or saline solutions (water and salt), alcohol or chlorhexidine. Rigorous plaque control programs along with periodontal scaling and curettage also have proved to be helpful, although according to the American Dental Association, periodontal scaling and root planing are considered as a treatment to periodontal disease, not as a preventive treatment for periodontal disease^[2].

In many countries, such as the United States, mouthwashes containing chlorhexidine are available only by prescription.

Researchers analyzed government data on calcium consumption and periodontal disease indicators in nearly 13,000 U.S. adults. They found that men and women who had calcium intakes of fewer than 500 milligrams, or about half the recommended dietary allowance, were almost twice as likely to have gum disease, as measured by the loss of attachment of the gums from the teeth. The association was particularly evident for people in their 20s and 30s.^[3]

Research says the connection between calcium and gum disease is likely due to calcium’s role in building density in the alveolar bone that supports the teeth.^{[citation needed]}

Preventing gum disease may also benefit a healthy heart. According to physicians with The Institute for Good Medicine at the Pennsylvania Medical Society, good oral health can reduce risk of cardiac events. Poor oral health can lead to infections that can travel within the bloodstream.^[4]

Diagnosis

It is recommended that a dental hygienist or dentist be seen after the signs of gingivitis appear. A dental hygienist or dentist will check for the symptoms of gingivitis, and may also examine the amount of plaque in the oral cavity. A dental hygienist or dentist will also look for signs of periodontitis using X-rays or periodontal probing as well as other methods.

Hypervitaminosis A, otherwise known as excess Vitamin A in the diet, has also been linked to gingivitis in cats and dogs.^{[citation needed]} Whether this is applicable to humans remains unclear.

If gingivitis is not responsive to treatment, referral to a periodontist (a specialist in diseases of the gingiva and bone around teeth and dental implants) for further treatment may be necessary.

Complications

• Tooth loss
• Recurrence of gingivitis
• Periodontitis
• Infection or abscess of the gingiva or the jaw bones
• Trench mouth (bacterial infection and ulceration of the gums)

References

See also

• Periodontist
• Periodontitis

External links

• Good Oral Health Can Help Your Heart, The Institute for Good Medicine at the Pennsylvania Medical Society
• Gingivitis - Medline plus