A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. Generally, gingivitis resolves with good oral hygiene – longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.

In mild cases of gingivitis, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately.

Gingivitis is “Inflammation of the gingiva as a response to bacterial plaque on adjacent teeth; characterized by erythema, edema, and fibrous enlargement of the gingiva without resorption of the underlying alveolar bone.”

(Top) Severe gingivitis before treatment.
(Bottom) After mechanical debridement of teeth and surrounding gum tissues

There are two main categories of gingival diseases

Dental plaque-induced gingival disease
Gingivitis caused only by plaque
Gingivitis caused by systemic factors
Gingivitis caused by medications
Gingivitis caused by malnutrition

• Non-plaque induced gingival lesions
  Gingival diseases – caused by a specific bacterium
  Gingival diseases – caused by a specific virus
  Gingival diseases – caused by a specific fungus
  Gingival diseases – caused by genetic factors
  Gum inflammations caused by systemic conditions
  Gum inflammations caused by traumatic lesions
  Gum inflammations caused by reactions to foreign bodies
  Gum inflammations without known causes

What are the signs and symptoms of gingivitis?

A symptom is something the patient feels and describes, such as painful gums, while a sign is something everybody, including the doctor or nurse can see, such as swelling.

In mild cases of gingivitis there may be no discomfort or noticeable symptoms.

Signs and symptoms of gingivitis may include:

• Gums are bright red or purple
• Gums are tender, and sometimes painful to the touch
• Gums bleed easily when brushing teeth or flossing
• Halitosis(bad breath)
• Inflammation (swollen gums)
• Receding gums
• Soft gums

What are the causes of gingivitis?

The accumulation of plaque and tartar

The most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth, which triggers an immune response, which in turn can eventually lead to the destruction of gingival tissue, and eventually further complications, including the loss of teeth.

Dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonizing bacteria that are trying to stick to the smooth surface of a tooth. Some experts say that they might help protect the mouth from the colonization of harmful microorganisms. However, dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis.

When plaque is not removed adequately, it causes an accumulation of calculus (tartar – it has a yellow color) at the base of the teeth, near the gums. Calculus is harder to remove, and can only be removed professionally.

Plaque and tartar eventually irritate the gums.

Gingivitis may also have other causes, including:

• Changes in hormones – which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva may become more sensitive, raising the risk of inflammation.
• Some diseases – such as cancer, diabetes, and HIVare linked to a higher risk of developing gingivitis.
• Drugs – oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin (anticonvulsant), and some anti-angina medications may also cause abnormal growth of gum tissue.
• Smoking – regular smokers more commonly develop gingivitis compared to non-smokers.
• Family history – experts say that people whose parent(s) has/had gingivitis, have a higher risk of developing it themselves.

Diagnosing gingivitis

A dentist or oral hygienist checks for gingivitis symptoms, such as plaque and tartar in the oral cavity.

Checking for signs of periodontitis may also be recommended; this may be done by X-ray or periodontal probing.

What are the treatment options for gingivitis?

If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home.

Gingivitis care with a dental professional:

• Plaque and tartar are removed. This is known as scaling. Some patients may find scaling uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
• The dental professional explains to the patient the importance of oral hygiene, and how to effectively brush his/her teeth, as well as flossing
• Periodically following-up on the patient, with further cleaning if necessary
• Fixing teeth so that oral hygiene can be done effectively. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar (they may also irritate the gums).

What the patient can do at home:

• Brush your teeth at least twice a day
• Bear in mind that in most cases, electric toothbrushes do a better job than we can do on our own
• Floss your teeth at least once a day
• Regularly rinse your mouth with an antiseptic mouthwash. Ask your dentist to recommend one.

What are the possible complications from gingivitis?

In the vast majority of cases, if gingivitis is treated and the patient follows the dental health professional’s instructions, there are no complications. However, if the condition is left untreated, gum disease can spread and affect tissue, teeth and bones, leading to periodontitis.

Possible complications from gingivitis may include:

• Abscess in the gingiva
• Abscess in the jaw bones
• Infection in the jaw bone or gingiva
• Periodontitis – this is a more serious condition that can lead to loss of teeth
• Recurrent gingivitis
• Trench mouth – ulceration of the gums caused by bacterial infection

Several studies have linked gum diseases, such as periodontitis, to cardiovascular diseases, including heart attack or stroke. Other reports have found an association with lung disease risk.

Written by Christian Nordqvist
Copyright: Medical News Today

Two new studies give further insights into the links between mouth hygiene, gum disease and cardiovascular events. Researchers found that dental patients who had their teeth cleaned and scaled professionally had reduced risks of heart attack and stroke, while researchers in Sweden find that the type of periodontal or gum disease may predict degree of risks for heart attack, stroke and heart failure Both studies are presented this week at the American Heart Association’s (AHA’s).

In their nationwide, population-based study, Drs Emily (Zu-Yin) Chen and Hsin-Bang Leu from the Cardiology department at Taipei Veterans General Hospital, examined data on over 51,000 adults who had received at least one full or partial tooth scaling from a dentist or dental hygienist, and a similar number of matched controls who had never had their teeth professionally cleaned. None of the participants had a history of stroke or heart attack.

The data came from Taiwan National Health insurance records, and the researchers ran statistical tests to compare the cardiovascular event rates between the two groups for an average follow- up of seven years. They found that participants who had their teeth professionally scaled frequently or occasionally had a 24% lower risk of heart attack and a 13% lower risk of stroke compared to those who did not.

The researchers considered tooth scaling frequent if it occurred at least twice or more in two years, and considered it occasional if it happened once or less in two years. Chen, a cardiology fellow at Taipei Veterans General Hospital, told the press: “Protection from heart disease and stroke was more pronounced in participants who got tooth scaling at least once a year.” She suggested that professional tooth scaling removes inflammation-causing bacteria that in turn can lead to heart disease and stroke. One drawback of the study is that the researchers did not adjust the results to take into account other potential risk factors for cardiovascular disease, such as weight, smoking and race, since this information wasn’t in the health records.

The Swedish study was the work of Dr Anders Holmlund of the Centre for Research and Development of the County Council of Gävleborg, and senior consultant, Specialized Dentistry, and Dr Lars from the Department of Acute Medicine at Uppsala Academic Hospital. They examined data on 7,999 participants with periodontal or gum disease and found that types of gum disease predict risk for heart attack, congestive heart failure and stroke in different ways and to different degrees. Afer adjusting for age, gender, smoking and education level, their results showed that: Participants who had fewer than 21 teeth had a 69% higher risk of heart attack compared to those who had the most teeth. Participants with most infection (ie the highest number of deepended periodontal pockets around the base of the teeth) had a 53% higher risk of heart attack compared to those with the least infection (fewest number of pockets). The participants with the fewest number of teeth had 2.5 times the risk of congestive heart failure compared to those with the most teeth. Those with the highest incidence of gum bleeding had 2.1 times the risk of stroke compared to participants with the lowest incidence.

Holmlund and Lars concluded that: “Markers of periodontal disease predict future common cardiovascular events in different ways, suggesting that they are risk indicators for different cardiovascular disorders.”

Written by Catharine Paddock PhD