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Gingivitis and Gum Disease Basics

It afflicts as many as nine in ten adults at some point in their lives, as well as teenagers and children as young as five or six years of age. Yet, many suffer from it without even suspecting anything is wrong.

"It" is periodontal disease, or gingivitis - in the minds of most dentists, Public Enemy Number one for teeth.

Only for the last 30 years have researchers understood that gum disease is an infectious disorder, caused by many different species of bacteria. But even today, there is no cure. Fortunately, we have learned a good deal about what periodontal disease is and what can be done about it.

Behind the scenes

The culprits in gum disease are the bacteria that thrive in the crevices between gums and teeth, accumulating in the form of plaque, a hard, colorless film. Plaque produces toxins that not only irritate gums and cause bad breath, but can eventually attack connective tissue, bone and teeth.

These crevices become "pockets" where the bacteria lodge and begin to erode the tissues that connect gums with teeth. If periodontal disease isn't checked, the pockets deepen. The havoc spreads. Eventually, the bone around the teeth and roots is destroyed - and the teeth soon follow.

Sounding the alarm

How can you tell if you have a periodontal problem?

If you have bleeding gums or if you have swollen gums, gingivitis may be the reason why. But mouth disease can strike silently, without any pain or obvious signs.

Any bleeding from your gums should be a tip-off. Make sure you're doing a thorough but gentle job of brushing and flossing every day. If bleeding persists, it's time to see your periodontist. Different people have different levels of susceptibility to periodontal disease, and some forms - including those that affect children and adolescents - can develop quite rapidly.

Not everyone who has gingivitis disease goes on to develop more serious periodontal problems. Some people manage to reverse the disease or stop the progress of chronic gingivitis when it flares up.

Until there's a cure, the fundamentals of gum disease prevention - regular professional care and careful brushing and flossing at home - are still the best line of offense for good dental health.

Ways to fight back

• Periodontal disease can be checked and often reversed with simple preventive measures: brushing, flossing and professional cleaning to remove plaque and stimulate gum circulation.
• If the problem has become more serious, the dentist may do what's called scaling and planing - deep scraping of plaque from under the gum line, and smoothing of root and tooth surfaces so gum tissues have a better chance to reattach.
• Promising new gum disease treatment is already on the horizon: antiseptic or antibiotic drugs placed at the site of infection. And new chlorhexidine mouthwashes that may help prevent the formation of plaque.

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Risk Factors For Gingivitis and Periodontitis

It is well established that the main cause of gingivitis, or periodontal disease, is bacterial plaque. But not everyone responds the same to the same bacterial infection. There are many factors that can contribute to making someone more or less susceptible to the progression of periodontitis. These factors are called risk factors. They can increase the risk, severity, and speed at which the disease develops. Some risk factors can be modified. If they are, gum disease and tissue destruction can be controlled and maybe even prevented with periodontal treatment.

There are several factors that can put individuals at greater risk for gingivitis or periodontal disease.

2. Crowded Teeth: Crowded teeth can contribute to plaque retention and interfere with oral hygiene. If this becomes a problem, it may be necessary to reshape the teeth or move them to a better position with the use of dental appliances or braces.

3. Poor Fitting Dentures, Fillings, or Crowns: These factors also may contribute to plaque retention and interfere with oral hygiene methods. If this is the case, the restorations may need to be reshaped, polished, or even replaced.

4. Occlusion (the way the teeth bite or come together): The forces created by an unbalanced bite, by clenching, or by grinding of the teeth, can accelerate the progression of bone destruction and periodontal disease. These forces can also contribute to excessive wear of the teeth, fractures, temporomandibular joint (TMJ) problems, or root canal problems. People who clench or grind their teeth may not be conscious of it, but may experience sore jaw muscles, TMJ problems, headaches, and neck or shoulder pain. Most people are more susceptible to clenching or grinding during periods of high stress. These habits can be controlled and treated with specially made dental appliances (night guards), braces, reshaping of the biting surfaces of the teeth, exercises, medications, or a combination of the above.

5. Tobacco: People who smoke or chew tobacco are more likely to have periodontitis. They also are more likely to have a poorer and slower response to periodontal treatment. The risk of acquiring periodontal disease decreases after smoking cessation and former smokers and non-smokers respond the same to treatment from a periodontist. Smoking cessation is beneficial to periodontal and overall health.

6. Poor Nutrition: Although periodontal disease is not caused by nutritional deficiency, a diet low in nutrients can diminish the effectiveness of the body's immune system. This reduces the resistance to infections such as periodontitis. To aid in the body's capacity to fight infections, maintain a well-balanced diet and avoid fad diets that exclude entire food groups and limit nutrients.

7. Stress: Stress reduces the immune response and makes it hard for the body to fight infection. A study has shown that people who are under financial stress and have poor coping ability have a two-fold increase in the incidence of periodontal disease.

8. Pregnancy and Female Hormonal Changes: The hormonal changes that occur during pregnancy, puberty, and menstruation can make the gums more sensitive to bacterial plaque and increase the risk for periodontal disease. Pre-existing periodontal problems can become more severe if plaque is not controlled. So an efficient and consistent plaque control program is essential in maintaining periodontal health through pregnancy and all stages of life.

9. Systemic Diseases: Certain systemic (general body) diseases, such as AIDS and diabetes, may decrease the body's ability to fight infection and can result in more severe periodontal disease. Always keep your dental care provider informed of changes in medical status.

10. Medication: Drugs such as birth control pills, immunosuppressants, anti-depressants, and some heart medications can also increase the risk for periodontal disease. Patients should inform their dental care provider of any changes in the medications that they may be taking.

11. Genetics: Up to 30% of the population may have a gene that is linked with an increased susceptibility to periodontal disease. Although genetics is not modifiable, knowing one's genetic profile puts individuals in a proactive position regarding dental health. Through proper home care, periodontal maintenance visits, modification of known risk factors, and early intervention, individuals have an excellent chance of keeping their teeth for a lifetime.

By Laura Minsk, DMD