Overview

Gum inflammation or gingivitis usually precedes periodontitis or gum disease. It is important to note that not all gingivitis will progress to periodontitis.

In the early stage of gum inflammation, there is bacteria buildup in the plaque, which causes the gums to become inflamed. Inflamed gums easily bleed during tooth brushing. While it may cause an irritation of the gums, the gums remain firmly planted in their sockets. At this stage, there is no irreversible bone or tissue damage has occurred.

When the inflamed gum is not properly addressed, it may lead to periodontitis or gum disease. When a person has gum disease, the inner layer of his gum and bone pull away from the teeth and form pockets. These pockets or small spaces between teeth and gums collect debris and cause infection. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line.

The toxins produced by the bacteria in plaque and the body’s good enzymes involved in fighting infections will start breaking down the bones and connective tissue that hold the teeth in place. As the disease continues to progress, the pockets become deeper and more gum tissue and bone will be destroyed. When this occurs, the teeth are no longer securely anchored in place and they become loose, which could be the beginning of tooth loss. Gum disease is the leading cause of tooth loss in adults.

Gum disease is very common but largely preventable. It is usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily, and getting regular dental checkups will significantly lessen your risk of gum disease. If you already have the beginning of gum disease, good oral hygiene could reverse the condition. You can reduce of risk of having gum disease by practicing good oral hygiene.

There are several types of gum disease or periodontitis. The more common types include:

• Chronic periodontitis – It is the most common type, which affects mostly adults although children may be affected, too. This type of periodontitis is caused by plaque buildup and involves a slow deterioration of the condition that may improve or get worse over time. It causes destruction in the gums and bone, resulting in loss of teeth if not properly addressed.
• Aggressive periodontitis – This type begins typically in childhood or early adulthood. It affects only a small number of people. This condition tends to affect families and caused rapid progression of bone loss and tooth loss if not addressed properly.
• Necrotizing periodontal disease – This condition is characterized by the death of the gum tissue, tooth ligaments, and supporting bone due to the lack of blood supply, which results in infection. This type of gum disease typically occurs in people with a compromised immune system, such as from HIV infection, cancer treatment, and other causes, including malnutrition.

Causes of Gum Disease

In most cases, gum disease begins with plaque – the sticky film composed mainly of bacteria. If not treated properly, plaque can eventually advance to gum disease following these steps:

• Formation of plaque on your teeth – Plaque starts forming when starches and sugars in food that you eat interact with bacteria that normally inhabits your mouth. Brushing your teeth twice daily and flossing once daily remove plaque, which can re-form quickly.
• Hardening of plaque under your gumline into tartar or calculus – When not removed by brushing, flossing or dental cleaning, plaque will stay in your teeth and harden to become tartar. Tartar is much more difficult to remove as it is filled with bacteria. The longer you have plaque and tartar on your teeth, the more damage they can bring. Tartar cannot be removed simply by brushing and flossing. You will need professional dental cleaning to remove it.
• Plaque causes gingivitis – The formation of plaque is the beginning of gingivitis, which is the mildest form of periodontal disease. Gingivitis is inflammation and irritation of the part of your gum around the base of your teeth – gingiva. Gingivitis is reversible as long as you will get professional dental treatment and good home oral care.
• Ongoing inflammation of the gum may lead to periodontitis or gum disease – When the inflammation of the gum is not treated, it may eventually lead to pockets developing between your gum and teeth. The pockets are filled with plaque, tartar, and bacteria. Over time, these pockets will become deeper, filling them with more bacteria. If left untreated, the deep infections can result in a loss of tissue and bone. Ultimately, you may lose one or more teeth. Ongoing chronic inflammation of the gums may put a strain on your immune system.

Symptoms of gum disease

Healthy gums are firm and pale pink in color. They fit snuggly around the teeth. You have gum disease when you observe the following symptoms:

• Swollen or puffy gums
• Bright red, purplish or dusky red gums
• Gums that easily bleed
• Gums that feel tender when touched
• Gums that recede from your teeth, making your teeth look longer than normal
• Pus between the teeth and gums
• New spaces developing between your teeth
• Loose teeth
• Bad breath
• Painful chewing
• A change in the way your teeth fit together when you bite

Diagnosis and Treatment

Diagnosis

When you visit a dentist, your dentist or dental hygienist will do the following:

• Check your gums and take notes of any signs of inflammation
• Use a probe, which is a tiny ruler, to check for and measure any pockets around the teeth. In a healthy mouth, the depth of the pockets is typically between 1 and 3 millimeters.
• Review medical history and look for conditions or risk factors

The dentist may also:

• Take an x-ray to see whether there is any bone loss
• Refer you to a periodontist, an expert in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

Treatment

The main goal of treatment for diuretics is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The dentist may recommend changing certain behaviors, such as quitting smoking, as a way to improve your treatment results.

Good oral hygiene

Good oral hygiene must be performed daily, even if the teeth and gums are healthy, to prevent infection.

Proper dental care involves brushing teeth at least twice daily and flossing once daily. If there is enough space between the teeth, an interdental brush will help.

Scaling and cleaning

The removal of plaque and calculus is important to restore periodontal health. A health care professional will carry out scaling and debridement to clean below the gumline. This is done using hand tools or an ultrasonic device that breaks up the plaque and calculus. Root planing is done to smooth rough areas on the roots of the teeth. Bacteria can lodge within the rough patches, which can increase the risk of gum disease.

The process may take one or two visits depending on how much plaque and calculus you have. Cleaning is normally recommended twice a year.

Medications

A number of medicated mouthwashes and other treatments are available:

• A prescription antimicrobial mouth rinse, such as chlorhexidine
• Antiseptic chip
• Antibiotic gel
• Antibiotic microspheres
• Enzyme suppressant
• Oral antibiotics

Advanced periodontitis

If good oral hygiene and non-surgical treatments are not effective, surgical intervention may be needed. The options include:

• Flap surgery – It involves removal of calculus in the deep pockets, or to reduce the pocket to make cleaning easier.
• Bone and tissue grafts – This procedure helps regenerate bone or gum tissue that has been destroyed. New natural or synthetic bone is placed where the bone was lost. This is aimed to promote bone growth.

What are the normal conditions

Healthy gums should be a relatively consistent shade of pink they may appear slightly lighter around the teeth and darker around the sides of the mouth. One person’s gums may be naturally a little paler or darker than another’s.

Risk of Having Gum Diseases

There are factors that can increase the risk of gum disease, including:

• Gingivitis
• Smoking or chewing tobacco
• Poor oral health habits
• Older age
• Substance abuse
• Hormonal changes, such as those related to menopause or pregnancy
• Inadequate nutrition, including vitamin C deficiency
• Obesity
• Genetics
• Certain medications that cause dry mouth or gum changes
• Certain diseases, such as diabetes, Crohn’s disease, and rheumatoid arthritis
• Conditions that cause decreased immunity, such as leukemia, cancer treatment, and HIV/AIDS

When to Seek Medical Attention

A dentist provides major care for diseases of the teeth and gums. A person should visit his or her dentist for the following concerns:

• Gums start to bleed
• Gums are swollen and score
• Bad-smelling breath or a bad taste develops in the mouth
• Gums become very red or very pale
• Teeth are painful
• Loose teeth in their sockets

If the symptoms are present, together with fever, sweats, chills, or face swelling, it is time to the nearest emergency room of a hospital.

There are other reasons why you should go to an emergency department include the following:

• The tongue feels swollen or pushes up from the floor of the mouth
• Swelling develops below the chin, especially if it is red, tender, and warm.