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Gingivitis - Everything You Need To Know

Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.

In small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These gingivitis bacteria release toxins that result in inflammation of the gum tissue and bad breath.

Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.

Signs of Gingivitis

Gingivitis can be identified by red or swollen gums. In some circumstances, the gingivitis can cause bleeding gums when brushing or eating, and there may be bad breath. To diagnose gingivitis, a dentist may probe gently under the gums. In healthy gums, there should not be any bleeding with this gentle probing. A bleeding gum indicates that there is gum inflammation or gingivitis.

Who's At Risk for Gingivitis?

Certain people are more susceptible to gingivitis. Stress, smoking and poor nutrition can contribute to the development of gingivitis. Certain medications such as steroids, heart medications, cancer therapy drugs, anti-epilepsy drugs, and anti-depressants also increase the risk for gingivitis.

In the presence of plaque, these medications can lead to gum overgrowth. The enlarged gums can further interfere with oral hygiene, precipitating a vicious cycle of further gum enlargement.

Changes in female hormones can also increase the vulnerability to gingivitis. Adolescent women, pregnant women and women who take hormone replacement or birth control pills also have a greater risk of developing gingivitis.

There are several systemic illnesses that are associated with gingivitis. These include

• acute leukemia
• Addison's disease
• diabetes
• hemophilia
• immunodeficiency diseases (including HIV)

The swelling and redness of the gums may be disproportional to the amount of plaque present. To prevent further complications, meticulous plaque control is critical for people with these illnesses.

Gingivitis Treatment

For gingivitis treatment, the bacterial plaque and tartar have to be removed from the surfaces of the teeth by a dentist or hygienist. Then, the factors that contribute to plaque retention have to be altered in order to facilitate oral hygiene procedures.

This can involve re-shaping existing restorations or even moving teeth with braces so that they are not crowded. Essential to the success of the gingivitis treatment is the person's ability to control plaque build-up after initial treatment. Daily brushing and flossing are key to gingivitis prevention and helps prevent bad breath.

If there is a lot of gum inflammation, if the gums are very sensitive, or if there is a lot of tartar buildup, it may be necessary to numb the gums in order to remove the buildup of bacteria underneath the gum margins. If the gum is very inflamed and swollen, it may be necessary to remove some of the excess gum tissue surgically.

Gingivitis is reversible, and with proper gingivitis treatment and maintenance, it can be controlled. However, untreated gingivitis can result in gum defects, bone loss around the teeth, and eventual tooth loss and systemic complications. The best way to prevent gingivitis is by brushing and flossing daily, and by visiting the dentist for a routine cleaning and an examination at least every six months.

By Laura Minsk, DMD

Dental Procedure, Pocket Depth Reduction

As the bacteria that cause periodontal disease release toxic substances, they trigger the breakdown of gum and bone. The gum then separates from the teeth, forming gaps that are called periodontal pockets. Bacteria settle in these pockets and because they cannot be removed by the patient's daily oral hygiene, they continue to accumulate and reproduce. Without proper treatment, the bacteria will continue to populate these pockets, creating further gum and bone destruction.

The first step in the treatment of periodontal disease involves the removal of the bacteria that inhabit the periodontal pockets in the form of plaque and tartar. The removal of the pocket irritants, scaling and root planing is combined with oral hygiene instructions that are aimed at improving the patient's ability to control plaque and avoid bacteria from re-infecting the periodontal pockets. Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed to assess the healing response. If the periodontal pockets do not reduce to below 4 mm and the gums are still unhealthy, surgical treatment may be indicated.

Pocket depth reduction is a term used for a series of different surgical procedures (gingivectomy, flap surgery, osseous surgery). The purpose of these procedures is to gain access to the root surface to effectively remove calculus and to reduce the size of the pockets to help prevent bacteria from settling in.

What to Expect

Pocket depth reduction is done in the dentist's office with local anesthesia (lidocaine). After lifting the gum back, the bacterial plaque and tartar are removed from the root surfaces. It also may be necessary to remove the infected gum tissue and to smooth the bone surface. Stitches (sutures) are placed to aid in healing. The stitches are usually removed five to ten days after the surgery. Follow-up appointments are scheduled as necessary to evaluate healing and plaque control.

Post-surgical discomfort may last a few days and is usually minimal. It can be easily managed with commonly available over-the-counter medications such as aspirin, acetaminophen, or ibuprofen. Patients can expect to follow their normal routine the day after surgery. A dentist will provide special instructions related to diet, exercise, and medications.

After pocket depth reduction, patients may experience heightened tooth sensitivity. This is temporary and usually resolves within a few weeks. There are chemical aids available that help reduce sensitivity.

Some people also may experience looser teeth after periodontal surgery. This also is a transient finding that occurs as part of the normal healing process. With proper plaque control and bite adjustment, the teeth usually tighten up in a few weeks.

Another concern after pocket depth reduction is that the teeth may appear longer and that there are spaces in between the teeth. Actually, longer teeth are the result of periodontal disease, not of periodontal surgery. As periodontal disease infects and destroys the bone that encases the roots, the root surfaces become exposed. They do not appear exposed because they are covered by the inflamed, swollen gums that form the periodontal pocket. Without proper treatment, the periodontal pockets continue to deepen, giving way to more infection, bone loss, and eventually tooth loss and systemic complications.

There are treatments that can help improve esthetics after periodontal treatment. In addition to periodontal plastic surgery procedures, orthodontic tooth movement (braces) or restorative treatment (crown and bridges) can help create a more pleasing smile line.

Benefits

If periodontal pockets do not resolve after scaling and root planing, a dentist may recommend pocket depth reduction. Whether a dentist performs a gingivectomy, periodontal flap surgery, or osseous surgery, the patient will benefit from the reduction in pocket depth and the reattachment of the gums to the root surface. Pocket depth reduction, when followed by supportive periodontal treatment, is a predictable procedure that can help keep teeth healthy and reduce the risk of serious health problems related to periodontal disease. If a general dentist does not frequently do surgeries, he or she may refer the individual to a periodontist that specializes in this technique.

By Laura Minsk, DMD

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