Gingivitis

What is gingivitis?
Gingivitis, also called gum disease or periodontal disease, describes the events that begin with bacterial growth in your mouth and may end -- if not properly treated -- with tooth loss from destruction of the tissue that surrounds and supports your teeth. (Gingivitis and periodontitis are two distinct stages of gum disease.)

What’s the difference between gingivitis and periodontitis?
Gingivitis usually precedes periodontitis. However, it is important to know that not all gingivitis progresses to periodontitis.

In the early stage of gingivitis, bacteria in plaque build up and cause the gums to become inflamed (red and swollen) and often bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at 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 away from the teeth (recede) and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line.

Toxins, or poisons, produced by the bacteria in plaque as well as the body's "good" enzymes (involved in fighting infections), turn against the body and actually start to break 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 destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, in fact, is the leading cause of tooth loss in adults.

What causes periodontal disease?
Plaque is the primary cause of periodontal disease. However, other factors can contribute to gum disease. These include:

• Hormonal changes—such as those occurring during pregnancy, puberty, menopause, and monthly menstruation—make gums more sensitive, which makes it easier for gingivitis to develop.
• Illnesses, which may affect the condition of your gums. This includes diseases, such as cancer or HIV, that interfere with the immune system. Because diabetes affects the body’s ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.
• Medications—can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication diphenylhydantoin (marketed as Dilantin) and the anti-angina drug nifedipine (marketed as Procardia or Adalat), can cause abnormal growth of gum tissue.
• Bad habits, such as smoking, make it harder for gum tissue to repair itself.
• Poor oral hygiene habits, such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.
• Family history of dental disease can be a contributing factor in the development of gingivitis.

What are the symptoms of periodontal disease?
Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

• gums that bleed during and after tooth brushing
• red, swollen, or tender gums
• persistent bad breath or bad taste in the mouth
• receding gums
• formation of deep pockets between teeth and gums
• loose or shifting teeth
• changes in the way teeth fit together upon biting down, or in the fit of partial dentures.

Even if you don't notice any symptoms, you may still have some degree of gum disease. In some people, gum disease may affect only certain teeth, such as the molars. Only a dentist or a periodontist can recognize and determine the progression of gum disease.

How does my dentist diagnosis periodontal disease?
During a periodontal exam, your dentist or periodontist typically checks:

• your gums—for bleeding, swelling, firmness, and for pockets (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)
• your teeth—for movement and sensitivity
• your bite—for proper teeth alignment
• your jawbone—(via x-rays) to help detect the breakdown of bone surrounding your teeth

How is periodontal disease treated?
The goals of periodontal treatment are to promote reattachment of healthy gums to teeth; reduce swelling, the depth of pockets, and the risk of infection; and to stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments, and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.

How can gingivitis be prevented?
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 daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached; flossing removes food particles and plaque from in between the teeth and under the gum line.

Other health and lifestyle changes that will decrease the risk, the severity, and the speed of gum disease development include the following:

• Stop smoking—tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.
• Decrease your 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 (including vegetable oils, nuts, green leafy vegetables) or vitamin C (including 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.

The American Academy of Periodontology says that up to 30% of Americans may be genetically susceptible to gum disease, and may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk as well. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and treatments to better manage the gum disease.

Is it true that periodontal disease has been linked with other health problems?
According to the Centers for Disease Control and Prevention (CDC), researchers have uncovered potential links between periodontal 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, according to the CDC, these microorganisms are associated with health problems such as stroke and heart disease. Diabetes is not only a risk factor for periodontal disease, but periodontal disease may make diabetes worse.