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What is Gingivitis?

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Gingivitis is a periodontal disease caused by the inflammation of the gums. There are two types of gingivitis: dental plaque-induced gingival disease and non-plaque induced gingival disease. When left untreated, gingivitis can lead to periodontitis, a more serious infection that can lead to tooth loss.

Dental Plaque-induced Gingival Disease v. Non-plaque Induced Gingival Lesions

Dental plaque-induced gingival disease is gingivitis caused by plaque, systemic factors, medications and malnutrition. Non-plaque induced gingival lesions are a little more complex. They can be caused gingival diseases or gum inflammation. The gingival diseases normally result from fungi, genetic factors, specific bacterium or viruses. The gum inflammation can develop from reactions to foreign bodies, systemic conditions, traumatic lesions or unknown causes. 

What causes gingivitis?

The most common cause of gingivitis is the build-up of plaque around the teeth. This can trigger an immune response that decomposes the gingival tissue and surrounding structures. Plaque is a natural biofilm formed by accumulating bacteria that stick to the smooth surfaces of teeth. If the plaque remains, an accumulation of calculus (calcified plaque) forms at the base of the teeth near the gums. Calculus is much harder to remove and normally can only be removed professionally. Plaque and calculus can cause irritation to the gums and can make the gums pull away from the teeth causing “pockets”.

Reduced saliva flow is another common cause of gingivitis. This can be caused by (but is not limited to) smoking and medications that have anticonvulsants, anti-angina properties, and calcium channel blockers (CCBs). Gingivitis has also been linked to hormonal changes, which may occur during puberty, the menstrual cycle, pregnancy and menopause. Gums become more sensitive and susceptible to inflammation during these times, making it easier for gingivitis to develop. Diseases that weaken the immune system such as cancer, diabetes and HIV can also correlate to gingivitis. Risk factors to consider as well include broken fillings, crooked teeth, and poorly fitted dental appliances.   

Signs and Symptoms of Gingivitis

Painful, swollen gums are the most obvious signs and symptoms of gingivitis. It is only in mild cases that there is no discomfort or noticeable symptoms.

Other symptoms include:

  • Bleeding gums, especially when brushing or flossing
  • Bright red or purple gums
  • Halitosis (bad breath)
  • Lose teeth
  • Malocclusion (a change in how your teeth fit together when you bite)
  • Receding gums
  • Soft, tender gums

If you have any of these symptoms, talk to your periodontist immediately to prevent any further oral damage.

How Gingivitis is treated

Gingivitis can be successfully reversed if treated early on. Treatment normally involves a professional consultation followed procedures done at home by the patient. Cleaning teeth, medications and surgery are traditionally the treatment methods used.

Methods of cleaning teeth include lasers, root planing or scaling. Lasers are the least invasive method to cleaning teeth as opposed to root planing or scaling. Root planing is the process of removing infected tooth parts and smoothing rough spots. Scaling is the process of removing plaque and tarter. It may cause slight discomfort if the accumulation is extensive or the gums are sensitive.

When it comes to medications that treat gingivitis, there are many options to choose. Antibiotic microspheres, antibiotic mouthwashes, doxycycline, oral antibiotics and time-release antiseptic chips are some common types of medications given to patients. Antiobiotic microspheres are made with minocycline and are inserted after root planing and scaling. Antibiotic mouthwash contains chlorhexidine to disinfect the mouth. Doxycycline is an antibiotic that prevents enzymes from causing tooth damage. Oral antibiotics are often used for persistent areas of gingivitis. Time-release antiseptic chips contain chlorhexidine that are inserted after root planing and scaling, much like the antibiotic microspheres.

When gingivitis progresses to periodontitis, it is typically treated either non-surgically or surgically.  Surgical methods include flap surgery and bone and tissue grafts. In flap surgery, the gums are lifted back to remove plaque and calculus and then sutured in place to fit snugly around the teeth. Bone and tissue grafts are used in some cases if the teeth and jaw are too damaged to heal on their own.

Follow-ups are also recommended and a customized maintenance schedule adopted. Poor restoration margins may need to be corrected as well to help prevent plaque accumulation and aid in oral hygiene efforts. It is important for patients to follow instructions given by their periodontists to have the most successful results.

How Can You Prevent Gingivitis?

Simple steps can prevent gingivitis. Consistent, proper oral hygiene is key to ensure a healthy mouth.

Some preventative methods include:

  • Brushing your teeth twice a day (electric toothbrushes can do a better job than a manual toothbrush for some patients)
  • Flossing your teeth at least once a day
  • Regularly rinsing your mouth with antiseptic mouthwash

Of course, consulting your periodontist is always recommended to know what preventative methods work best for you.

If you think you or a loved one may have gingivitis, contact San Antonio Periodontics and Implants immediately to prevent further damage to your oral health.

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Guest Sunday, 17 December 2017

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