Gingivitis (gum inflammation) usually precedes bone loss (periodontitis or gum disease). However, it is important to know that not all gingivitis progresses to periodontitis.
In the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily bleed during tooth brushing and during professional cleanings. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred yet during this stage.
When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull and resorb away from the teeth to form pockets. These small spaces between teeth and gums collect debris and can become more inflamed and infected. The body elicits an immune response to fights the accumulation of bacterial plaque as it spreads and grows above as well as below the gum line.
Toxins (endotoxin poisons) -- produced both by the bacteria in plaque as well as the body's "good" enzymes involved in fighting infections -- begin breaking down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are permanently destroyed. Over time, teeth are no longer anchored in place, become loose, and tooth loss can occur. It is well known that Gum disease is the leading cause of tooth loss in adults.
Cause Of Gum Disease
Bacterial Plaque is the primary cause of gum disease. However, other factors can contribute to progression of periodontal disease. These include:
- Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive and easier for gingivitis to develop.
- Certain illnesses may affect the condition of your gums and how your gums progress with gingival inflammation. Cancer and HIV can interfere with the immune system. Because diabetes affects the body's ability to use blood sugar and ward off infections, patients with uncontrolled Diabetes tend to be at a higher risk of developing infections, including periodontal disease and cavities.
- Medications can affect oral health. Their side effects can lessen the flow of saliva (reduce the protective effect of saliva on teeth and gums). Some drugs, such as the anticonvulsant medication like Dilantin and Procardia (anti-angina medicine) and Adalat, can cause abnormal growth of gum tissue in the presence of plaque.
- Bad habits such as smoking can make it harder for gum tissue to repair itself and oftentimes masks the acute clinical inflammation of the gums.
- Poor oral hygiene habits including the ineffective completion of daily brushing and flossing, make it easier for gingivitis to develop.
- Family history of dental disease (Genetic predilection up to 82%) can also be a contributing factor for the development of gingivitis/ periodontitis.
What Are the Symptoms of Gum Disease?
Gum disease is normally considered a silent disease and oftentimes progresses painlessly, producing few obvious signs, even up to the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain clinical symptoms may point to indicate that a patient has some form of gum disease. The symptoms include:
- Gums that bleed during and after tooth brushing
- Red, swollen, or tender gums (localized or generalized)
- Persistent bad breath or bad taste in the mouth (Halitosis)
- Receding gums
- Formation of deep pockets between teeth and gums (5mm or greater)
- Loose or teeth shifting position over time (Spacing that develops between teeth)
- Changes in the way teeth fit together upon biting down
Even if you don't notice any symptoms, you may still have some degree of gum disease. In some people, gum disease only affects certain teeth, such as the molars. It does not have to be Generalized. Only a dentist or a periodontist can recognize and determine what stage gum disease a patient presents with.
Diagnose Gum Disease
Gingivitis, also generally called early gum disease, begins with bacterial growth in your mouth and may progress -- if not properly treated -- with tooth loss due to destruction of the tissue (bone loss) that surrounds your teeth.
During a dental exam, your Periodontist typically checks for these things:
- Gum bleeding, swelling, firmness, and pocket depth (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)
- Teeth movement and sensitivity and proper alignment
An intra/extraoral examination will be completed to check for lumps and bumps and to verify that no potential pathology is present. It is critical to detect if any breakdown of the soft tissue or bone structures in or around your teeth so that proper early treatment can be completed.
Gum Disease Treatment
The goals of gum disease treatment are to promote reattachment of healthy gums to teeth; reduce swelling and the depth of pockets, and the risk of infection; and to stop disease progression. Controlling the environment of the pockets is critical to reduce the level of bacterial that can live and thrive in the gums. Treatment options depend on the specific stage of disease, how you may have responded to earlier treatments, and your overall general health. These options include nonsurgical therapies (including Scaling and Root planning, Oral Hygiene instructions, debridement of plaque and calculus buildups) control bacterial growth to help prevent surgical intervention and to help restore supportive tissue attachments around the teeth. A full description of the various treatment options is provided in Gum Disease Treatments.
Gum disease (gingivitis) can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and proper home care that includes daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth and can be effective to up to 1-2 mm subgingivally; flossing removes gross food particles and plaque from in between the teeth and up to 2-3mm under the gum line. Antibacterial mouth rinses (including Listerine) can reduce bacteria that cause plaque and gum disease and is an approved product according to the American Dental Association.
Gum Disease Prevention
While bacterial plaque is the primary cause of Gum disease. There are other health and lifestyle factors that can increase the risk, severity, and speed of gum disease development. These include:
- Stop smoking — Tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get gum disease than nonsmokers, and smoking over 10 cigarettes per day can lower the chances of success of some definitive gum treatments (including the long-term success rates of dental implants).
- Reduce stress — Stress may make it difficult for your body's immune system to fight off infection.
- Maintain a well-balanced diet — Proper nutrition helps your immune system fight infection. Eating foods with antioxidant properties -- for example, those containing vitamin E (vegetable oils, nuts, green leafy vegetables) and vitamin C (citrus fruits, broccoli, potatoes) -- can help your body repair damaged tissue.
- Avoid clenching and grinding your teeth — These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed especially when there is gingival inflammation present. Ask your dentist about fabricating a nighttime acrylic appliance to help protect your teeth from these damaging forces which affect both the wear to the teeth and the progression of bone loss when gingival inflammation is present.
Despite following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of Americans may be genetically susceptible to gum disease. And those who are genetically predisposed may be up to six times more likely to develop some form of gum disease (up to an 82% chance of being more susceptible compared to non-genetic causes. If anyone in your family has gum disease, it means that you are at greater risk to develop disease and should seek regular dental appointments to help reduce the chances of onset. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and early treatment recommendations to better manage and prevent the progression of the condition.
Gum Disease Linked to Other Health Problems?
Researchers have uncovered potential links between gum disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, these microorganisms are associated with health problems such as stroke, low birth-weight babies, and heart disease. Diabetes is not only a risk factor for gum disease, but the bacterial of gum disease may make diabetes less controlled.