What is gum disease (gingivitis)?
Gum disease, also known as periodontal disease, is a dental infection that can lead to a number of other complications. The milder form of gum disease, which is scientifically referred to as gingivitis, refers to the teeth’s surrounding tissues (gums) becoming inflamed, which is typically due to poor practices of oral and dental hygiene. Simply put, gingivitis results in the inflammation of the gingiva specifically, this is the part of the gum that is found at the base of the teeth.
Gum disease is a common condition that may vary widely in its severity. The condition is characterised by swollen and red gums that will easily bleed when brushing your teeth or flossing. Gingivitis is commonly confused with periodontitis, however, the two terms refer to two different conditions, although someone who suffers from gingivitis may also suffer from periodontitis as gingivitis that is left untreated can progress to periodontitis.
Periodontitis, which is pronounced “per-e-o-don-TIE-tis”, is a severe gum infection that results in damage done to the soft tissue that leads to the destruction of the teeth’s supporting bone. This can cause loosening of your teeth, tooth decay and eventually tooth loss.
Both gingivitis and periodontitis are forms of gum disease. Gingivitis should be taken seriously and treated accordingly so as to prevent the condition from developing into periodontitis.
Through good dental and hygiene habits, you may be able to prevent the condition and even reverse it.
These include the following:
- Brushing your teeth at least twice daily (morning and night)
- Flossing regularly
- Going for regular check-ups with your dentist
For the sake of this article, we will focus on gingivitis specifically. To add more depth to your understanding of periodontal (gum) disease, we will also briefly describe periodontitis.
What is the difference between gingivitis and periodontitis?
As stated, gingivitis that is left untreated can progress and develop into periodontitis, a condition that may lead to tooth loss as well as a number of other complications and health problems. The below explanation gives a brief outline on the difference between the two conditions:
This is the mildest form of gum disease, also known as periodontal disease, wherein the gums will become swollen, red and may bleed easily. At this stage, there is typically very little discomfort. Gingivitis can be reversed through professional dental care and personal oral hygiene.
The factors that may have a role to play in the development of gingivitis can include:
- Inadequate nutrition
- Genetic predispositions Diabetes
- Hormonal changes
- HIV infection
- Certain medications
- Systemic diseases
When gingivitis is left untreated, it can advance and develop into periodontitis. In time, the plaque (this is a sticky deposit/fill that covers your teeth and contains bacteria), may grow and spread below your gum line. The bacteria produces toxins that irritate your gums and creates an inflammatory response where your body basically attacks itself and the bone and tissues that support your teeth are targeted and destroyed by the immune system.
The gums will separate from your teeth and form pockets that are infected with the bacteria. When the condition progresses, these pockets will deepen and more bone and gum tissue will be destroyed. There are a number of different forms of periodontitis, each one having different symptoms and describing a different rate at which the condition progresses.
These forms include:
- Aggressive periodontitis – This involves the rapid loss of bone and detachment of teeth.
- Chronic periodontitis – This progression of bone and gum loss is normally slower with this form of the condition and is the most commonly seen form of periodontitis. This form is characterised by the formation of pockets in the gingiva.
- Periodontitis as a result of a systemic disease – This normally starts when the patient is young and can be linked to a number of systemic diseases including cancer, atherosclerotic cardiovascular disease, diabetes, rheumatoid arthritis, chronic kidney disease, respiratory disease, metabolic syndrome and obesity, amongst others.
- Necrotizing (flesh-eating) periodontal disease – This infection is characterised by the destruction of the gum tissues, bone and periodontal ligaments. These lesions tend to appear in those who have suppressed immune systems from conditions such as HIV and malnutrition.
What causes gingivitis?
As previously mentioned, poor dental hygiene is the most commonly seen cause of gingivitis as this encourages the formation of plaque on the teeth, resulting in the gum tissues becoming inflamed.
The following explains how plaque can cause gingivitis:
- Plaque forming on the teeth – Plaque is a sticky, invisible coating on your teeth that consists mainly of bacteria. Plaque forms when sugars and starches in the food you eat interact with the bacteria that naturally resides in your mouth. This plaque will need to be removed daily as it quickly reforms on a daily basis.
- Plaque turning into tartar – If plaque is not cleaned off of your teeth, it will stay on them and may harden under your gum lining and form into tartar, this is easily recognisable as it will be brown or yellow in colour on the teeth. Tartar is also known as calculus and is basically the hardened build-up of plaque that was not removed. This will then begin to collect more bacteria and make it difficult for the plaque to be removed as it creates a protective coating or shield for the bacteria, which results in your gum line becoming irritated. You will need to undergo professional cleaning by your dentist or an oral hygienist in order for the tartar to be removed.
- Gingiva becoming inflamed (this is when gingivitis occurs) – When tartar and plaque are not removed and remain on your teeth, the more likely they are to irritate your gums (gingiva), specifically the area of your gums that surrounds the base of the teeth. This irritation is what causes inflammation. Over time, your gums may become red and swollen and may also bleed easily when brushing your teeth or eating. Tooth decay, known as dental caries, may also be a result of this infection. When gingivitis is left untreated, then this may progress to periodontitis or even tooth loss.
**My Med Memo: Plaque and tartar are two different substances. Plaque is the colourless, sticky coating that forms on your teeth and consists mainly of bacteria and food debris.
Plaque can be easily removed by brushing your teeth twice a day. Plaque can cause issues such as cavities when the acids that it produces attack the teeth and gums.
Tartar is a hard, non-sticky deposit that creates a rough surface on your teeth which allows for bacteria to easily latch on. Plaque hardens and develops into tartar. Tartar consists mainly of mineral deposits from your saliva and is only able to be removed by your dentist or an oral hygienist, otherwise, it may lead to periodontal disease.
Does gum disease cause bad breath?
Halitosis (the scientific term for bad breath), is an extremely common condition that is linked to several different causes. Chronic bad breath is normally a result of gases (which often have a foul smell) being released from the bacteria that naturally coats your gums, tongue and teeth. In some cases, there are bits of food that are not brushed or flossed out from between your teeth, this leaves the food to rot and creates an unpleasant odour.
The bacteria on your gums and teeth, known as plaque, is what causes gum disease and may even lead to tooth decay. One of the most commonly seen warning signs associated with gum disease is bad breath or having an unpleasant taste in your mouth. Bad breath can be prevented or reversed through brushing your teeth twice a day and flossing on a regular basis (once a day). It is also advisable that you regularly have your teeth professionally cleaned by your dentist or an oral hygienist.
What are the risk factors of gingivitis?
Gingivitis can affect anyone and it is a common condition. There are a number of factors that have been identified to increase one’s chances of the infection developing, these may include:
- Poor oral hygiene habits
- Chewing or smoking tobacco
- Dry mouth – Also known as xerostomia, this is a condition that results in a sticky or dry feeling in one’s mouth and is often accompanied by frequent thirst and bad breath. Not having enough saliva in the mouth to cleanse the teeth, gums and tongue and to digest food can result in bacteria building up in the mouth.
- Old age
- Poor nutrition
- Crooked teeth that cannot be cleaned properly or having dental restorations (fillings) or correctional devices such as braces that are not fitted properly
- Conditions that result in immunosuppression such as cancer treatment (chemotherapy and/or radiation) or HIV
- Certain medications – These include phenytoin that is used for the treatment of epileptic seizures and some medications used for angina (chest pain) as well as high blood pressure.
- Hormonal changes that are related to birth control pills, pregnancy or one’s menstrual cycle
- Medical conditions that include fungal and viral infections
What are the complications of gingivitis?
If gingivitis is left untreated it can progress and spread to the underlying bone and tissue, this is when periodontitis occurs. This is a far more severe condition that may lead to tooth decay and tooth loss.
When you suffer from chronic gingiva (gum) inflammation, this is said to be linked to a number of systemic (affecting the entire body) conditions which include diabetes, stroke, rheumatoid arthritis and coronary artery disease. There is some research that suggests the bacteria that causes periodontitis can enter the bloodstream via the gum tissue and is able to affect your lungs, heart and other body parts. However, more research is needed in order for this association to be confirmed.
Another complication of progressive gingivitis is known as trench mouth, or NUG (necrotizing ulcerative gingivitis). This form of gum disease results in infected, bleeding and painful ulcerations and gums. Trench mouth is less commonly seen in more developed nations, although it is common among developing countries inflicted with poor living standards and nutrition.
How is gingivitis diagnosed?
Your dentist will typically diagnose gingivitis by:
- Reviewing your medical and dental history – This also includes investigating any current or past conditions or infections that may be contributing to your current symptoms.
- Examining your gums, teeth, tongue and mouth – This will be done to detect any signs of inflammation and plaque.
- Measuring your pocket depth – This is the groove between the teeth and gums. To examine this your dentist will insert a probe into your gum line (between your teeth and your gums) at a few different sites in your mouth. If you have a healthy mouth then the pocket depth will range from one to three millimetres (0.03 to 0.11 inches). If your pockets are deeper than four millimetres (0.16 inches), then this may indicate the presence of gum disease.
- Conducting dental X-rays – These will be conducted to examine your dental structure and detect if there is any bone loss in the areas your dentist has detected any deeper pockets.
- Performing any other tests that may be needed – If you dentist is unable to find a clear cause of gingivitis, then he or she may suggest that you have a medical evaluation done to detect any underlying health problems. If the gingivitis has advanced, then you may be referred to a periodontist (a doctor who specialises in gum disease), for a more thorough evaluation and treatment.
How is gingivitis treated?
In order for gingivitis to be treated effectively and for the outlook to be a positive one, it is best that you are treated promptly so as to prevent the condition’s progression and in turn the development of a more severe form of gum disease, tooth decay and potential tooth loss.
It is also best to stop the use of tobacco products and adopt a healthy regimen of good dental care to ensure that you have a higher chance of a full recovery.
The professional care for gingivitis includes the following:
- Dental cleaning – This will need to be done by your dentist or specialist who will remove all the plaque and tartar, as well as other bacterial products. This procedure is referred to as root planing or scaling. Scaling will remove the bacteria and tartar from the surfaces of your teeth, as well as any traces found under your gums. Root planing is a meticulous cleaning of the surfaces of your roots and will remove any bacterial products that are produced as a result of the inflammation. Root planing will also smooth the surfaces of the root, which will discourage any further build-up of bacteria or tartar as a smooth surface does not allow for the bacteria to latch onto the surface as easily. This will allow for the proper healing of the condition. Dental cleaning can be performed with dental instruments, an ultrasonic device or a laser.
- Restoring any dental fittings (if needed) – If there are any misaligned teeth, crowns that have been poorly fitted, as well as bridges or any other teeth restorations that may be irritating your gums or making it difficult for the plaque to be removed during dental care, then these need to be corrected and your dentist might suggest that he or she fix these issues to help rid your mouth of gum disease and prevent further infection.
- Ongoing care – A gum infection or inflammation will typically clear up once you have had a thorough cleaning by your dentist, coupled with practising dental and oral hygiene by brushing and flossing your teeth regularly. Your dentist may be able to assist you in putting together an effective routine and program to help you stick to keeping good care of your teeth. This plan will also include regular visits and check-ups with your dentist. When you are consistent with your oral hygiene, then you will be able to see your gum tissue return to a healthy state, being light pink in colour, in a number of weeks and in some cases, days.
What types of medication are used to treat gingivitis?
Your dentist will typically prescribe antibiotics to aid in eliminating the bacterial infection. Antibiotics therapy is often combined in a number of ways in assist in the treatment of gum disease. Types of gum disease and infections that make use of antibiotics for the treatment are:
- Trench mouth (ANUG - Acute Necrotizing Ulcerative Gingivitis) - This form of gum disease results in infected, bleeding and painful ulcerations and gums.
An antibiotic mouthwash known as Peridex (Chlorhexidine) is often prescribed. This assists in reducing the number of bacteria present in your mouth that contribute to the development of infection. In some cases, your dentist may give you small gels or pellets (PerioChip), that contain doxycycline or chlorhexidine. These are placed deep inside in the gum pockets once your dentist has conducted root planing or scaling, in order to eliminate the bacteria and also reduce the depth and size of the gum pockets caused by the infection.
The above-mentioned ways of administering antibiotics are extremely effective as the medications are slowly released over a period of seven days or more. You may also need additional pain medications such as NSAIDs (Nonsteroidal anti-inflammatory drugs) or xylocaine. These are commonly used in cases where the infection has progressed to ANUG (Trench Mouth) or chronic gingivitis.
What types of specialists treat gingivitis?
A periodontist is a dentist who has undergone additional training once they have completed dental school and specialised in diagnosing and treating disease of the bones, gums and teeth. If you have a more severe and advanced gingivitis infection, then you may be referred to a periodontist by your general dentist. Your dentist may first try to get rid of the tartar and plaque, after which you will see a specialist.
A periodontist may suggest a number of surgical or nonsurgical treatment options that are able to eliminate the infection and stabilise the condition of your gums. Periodontists are extremely skilled when it comes to conducting treatments of a number of oral conditions of the bone and gums. Some of these procedures include:
- Bone grafts – Surgery to fix issues associated with the bones in your mouth
- Functional and aesthetic gingivectomy – Surgical removal of the gum tissue
- Gingivoplasty – Surgical reshaping of the gums surrounding the teeth
- Crown lengthening
Bear in mind, the milder cases of gingivitis can be cured through practising oral hygiene at home at undergoing a professional dental cleaning. The aforementioned surgeries are typically conducted when gingivitis has progressed to periodontitis or trench mouth.
Can gingivitis be prevented?
It is possible for gingivitis to be reversed, as well as the progression of the infection slowed down and stopped in the majority of cases where there are practices of good oral hygiene present. In order for plaque to be controlled, you will need to have a professional cleaning conducted by your dentist bi-annually, along with flossing and brushing your teeth daily. Brushing will aid in eliminating any plaque that has accumulated on the surface of your teeth, flossing will remove the plaque and additional food particles found between your teeth or under your gum line.
There are also antibacterial mouthwashes available that are able to reduce the build-up of bacteria that result in plaque and cause gum disease.
There are a number of other lifestyle and health changes that are able to decrease the risk, progression and severity of gum disease. These include:
- Avoiding tobacco products – Tobacco found in cigarettes, hubbly bubbly (hookah) and a number of other products, is a major risk factor when gum disease is concerned. If you are a smoker, your chances of developing gum disease are seven times higher than those of a non-smoker. Smoking can also lower your chances of recovery when being treated for gum disease. When smoking products that contain nicotine, the nicotine will come into direct contact with your gums and can impact the functioning of the blood vessels in your mouth and eventually result in your gums becoming less vascular, meaning that there is far less blood supply than there should be. This compromises their healing potential and can result in the gums beginning to recede allowing for bacteria to target the bone that supports and surrounds your teeth.
- Reducing stress – Stress can make it more difficult for your immune system to defend itself against infection and heal the body from the condition. When the body is under attack from infection, it will produce antibodies (immune cells) to protect it against the infection. When you are stressed this delicate balance is affected and the existing inflammation from the infection can progress, allowing for bacteria to grow and thrive.
- Maintaining a nutritional and healthy diet – Sticking to a well-balanced eating plan that provides you with proper nutrition will aid in boosting your immune system to help it to fight off the infection. It is advised that you eat foods that have antioxidant properties, this includes foods containing vitamin C (broccoli, citrus fruits and potatoes) and vitamin E (nuts, leafy greens, vegetable oils) as these will assist the body in repairing tissue damage.
- Avoiding teeth gritting, grinding and clenching – These kinds of actions may increase the amount of tissue damage that occurs during gum disease as excess force is placed on the teeth’s supporting tissues. These sorts of habits will not cause the gum disease, but they can lead to the infection progressing as the applied pressure has been seen to speed up the destruction of the bone and periodontal ligaments.
How to practice good oral hygiene
What toothpaste should I use for gum disease?
Brushing your teeth will aid in the removal of the plaque that has accumulated on your teeth that allows for the harbouring of bacteria, these bacteria are what cause gum disease, and in more severe cases, tooth decay and loss. There are a number of effective toothpaste brands that will be able to help you to remove the plaque, most toothpastes sold in pharmacies and supermarkets are able to do the job.
There are a few ingredients found in toothpaste that assist in the removal of the plaque more efficiently. Calcium carbonates and silicates are known as abrasive agents that help to remove sticky plaque. The foaming effect seen in toothpaste is a result of the detergent known as sodium lauryl sulfate (SLS). Toothpaste tends to vary in the amount of SLS contained in them, when SLS is found in high amounts, this may cause issues for those who suffer from a low flow of saliva or dry mouth.
There are some brands of toothpaste that include zinc citrate and pyrophosphates, these are plaque-control ingredients and aid in preventing plaque from attaching to the teeth once they have been brushed.
It is advised that you use a toothpaste that contains a combination of the aforementioned ingredients so as to increase the efficiency of your oral hygiene routine.
To add to this routine, you should also include a mouthwash. Gargling with a mouthwash that contains essential-oils and dentifrice for 30 seconds after brushing your teeth can also aid in the prevention of plaque build-up.
How do I eliminate plaque on my teeth?
The most effective way to remove plaque, as previously mentioned, is to brush and clean your teeth twice a day. It is best to use a soft-bristled brush as hard- bristled brushes can cause your gums to recede from your teeth and damage the gum tissue. The shape and size of the toothbrush should easily enable you to reach all the areas of your mouth.
It is also best that you remove extra food particles by flossing once a day.
How do I brush and floss my teeth?
The following technique is recommended for brushing and flossing your teeth:
- Your toothbrush should be placed at a 45-degree angle adjacent to your gums.
- Move your toothbrush back and forth in a gentle motion. Be careful not to brush too hard as this can damage your gums.
- Make sure that you brush the inner and outer surfaces of the teeth, as well as the tops of your teeth (chewing surfaces).
- While using the tip of your toothbrush, clean the inner surfaces of your front teeth, this should be done in and downwards and upwards motion.
- Remember to brush your tongue as this can also harvest bacteria and is often the main cause of bad breath.
- It is best that you break off enough dental floss, you will need roughly 45 centimetres (18 inches). Wind the floss around your middle fingers, holding it tightly between the forefingers and thumbs.
- Make sure that you begin guiding the floss between the teeth, whilst making use of a soft rubbing motion.
- As the gum comes into contact with your gum line, curve it to resemble a C-shape against one tooth at a time. Gently slide the flood into the pocket between the tooth and the gum line.
- Once you have completed step three, then gently guide the floss back up to the point of contact between the adjacent teeth, then move the floss up and down the tooth next to the original one flossed.
- Make sure you keep the floss tightly against your tooth whilst gently rubbing the side of your tooth in an up and down motion.
- This method should be repeated on all of your teeth.
What else can be implemented to ensure I practise good oral hygiene?
In addition to daily flossing and brushing, you can also make use of a mouthwash/mouth rinse. Mouth rinses that are antimicrobial will aid in reducing the activity of plaque and accumulation of bacteria.
Mouth rinses that contain fluoride can also prevent or reduce tooth decay. It is always advisable to speak to your dentist about the best products to use and see what he or she suggests. Always check the labels of your products for age and health restrictions as young children (under the age of six years old) cannot use fluoride rinses due to the fact that too much fluoride in childhood years can cause a condition known as fluorosis which alters the texture and colour of the teeth, and also because young children may accidentally swallow mouthwash instead of spitting it out.
Is gum disease linked to other health issues?
Researchers and experts are still trying to determine and understand the link between systemic health issues and gum disease. Some systemic issues that have been linked to gum disease are a stroke, Alzheimer’s disease and heart disease. When the bacteria that causes the plaque on teeth has been compared to the bacteria that are involved in causing heart disease, there has been evidence that suggests that there is a correlation between heart disease and gum disease. However, experts are still unable to determine the exact cause-and-effect connection between the conditions.
These kinds of connections are hard to disprove or prove, therefore, it is generally accepted that should one aim for a healthy life that is not riddled with gum disease, this may be able to assist them leading a life that is generally healthier.
Although it may be difficult to find proof that suggests that there are health problems directly linked to gum disease, what is known is that certain health issues can result in the development of gum disease. If you have any changes to your current medical condition, then it is advised that you speak to your dentist or doctor to see if there may be some effects on your oral health. Your healthy gums can quickly be threatened if your immune system or health changes or diminishes for some reason.
Some more information on gum disease
Preventing gingivitis in children
Your child should start having their teeth brushed when they are roughly 12 months old.
You should only use a very small, pea-sized amount of toothpaste. When the gaps between his or her teeth begin to close, then it is vital that you also start flossing.
It is best to establish an oral hygiene routine with your children so that they can grow accustomed to it. When your child is old enough and able, you should teach them how to brush and floss by themselves and monitor them daily to ensure they are doing so. Your child should visit a dentist regularly from the age of two.
As a result of the hormonal changes in the body during puberty, gingivitis can become a common occurrence. Teenagers should, therefore, be monitored on a regular basis to ensure they are following a routine of good dental hygiene. It is advised that they are taken to a dentist for oral cleaning regularly.
**My Med Memo – It is generally advised that you should attend dental cleanings and check-ups at least twice a year. However, should your dentist detect any additional risk factors or health concerns, you may have to have a professional dental cleaning more frequently.
Gum disease in pregnant women
A number of pregnant women believe that dentists should be avoided in order to ensure that their foetus is not exposed to any danger from procedures or the drugs administered during these. However, dental cleanings should not be missed. Pregnant women are still at risk of developing gingivitis, and in actual fact, their risk of developing an infection is increased due to their increase in pregnancy hormones making their gum tissue more vulnerable to an infection from bacteria. Bleeding and swollen gums can sometimes be a symptom associated with pregnancy, if this is experienced then it may be advised that pregnant women see their dentist more regularly.
How gum disease can affect an expecting mother and her child
Cases of periodontal disease during pregnancy have shown that gum disease in pregnant women may expose their foetus to a number of different risks, these risks are particularly high in those who suffer from diabetes. There are several reasons as to why gum disease may have an impact on the health of a pregnant woman and her foetus.
These include some of the following:
- Prostaglandin – Gum disease (specifically periodontitis) seems to elevate prostaglandin levels, prostaglandin is a compound that aids in inducing labour. When these levels are increased, it may result in premature labour and the delivery of a premature baby.
- CRP (C – reactive protein) – This is a marker for blood tests that checks for the presence of inflammation in the body. CRP is a substance that is produced by the liver as a result of any inflammation, the levels of this protein are measured through a blood test, higher levels of it will denote an inflammation or infection. This protein has recently been associated with pregnancy outcomes such as premature birth and preeclampsia (a condition that is characterised by high blood pressure in pregnant women which can lead to seizures and a number of other complications). If an expecting mother suffers from a gum infection (periodontal disease), this may result in her CRP levels being elevated and this can intensify her body’s inflammatory response. It is possible for the bacteria that causes periodontal infection to enter through the bloodstream and result in the liver producing CRP, thus leading to inflammation of the arteries which could result in heart attacks or strokes.
**My Med Memo – The link between gum disease and preeclampsia is still under investigation and is a largely debated topic amongst medical professionals. However, in recent studies, there have been inconclusive findings between the correlation of the two conditions and therefore, the association cannot be confirmed.
- Bacterial spread – It is possible for the bacteria that accumulates within the gum pockets to enter the bloodstream and therefore affect a number of other body parts. Thus, the infection can become systemic. Research has shown that the oral bacteria in pregnant women, as well as some associated pathogens, have colonised and accumulated within the coronary arteries and internal mammary (breast tissue) glands of some women.
Treatment for gum disease in pregnant women
Fortunately, there are a number of non-surgical and safe treatment options for expecting mothers. It is vital that the progression of the infection is halted as this will increase the mother’s chances of a healthy and safe delivery.
A dentist will begin by assessing the current state of the jawbone and gums and then proceed to make an accurate and precise diagnosis. Root planing and scaling are the more common procedures performed as they do not require surgery and are minimally invasive. These involve removing the bacteria and debris that have colonised within the gum pockets and ridding the surfaces of the teeth of plaque and tartar. Through the use of effective treatment and sound personal oral hygiene, a pregnant woman’s chances of further complications caused by gum disease are reduced by roughly 50%.
Is gum disease contagious?
The majority of factors that cause gingivitis and other gum disease are generally based on your personal health. However, some scientific evidence, although limited, has confirmed that the bacteria that cause gum disease are able to spread through saliva. Therefore, periodontal disease itself is not contagious, but the bacteria that is responsible for the infection is.