Periodontal Disease -
Gingivitis

Periodontal Disease - Gingivitis: Overview

Periodontal (gum) diseases, including the two most common forms of gum disease called Gingivitis and Periodontitis (Pyorrhea), are serious infections that can lead to tooth loss if left untreated.  Periodontal disease results from a chronic bacterial infection that affects the gums and bone supporting the teeth.

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There are many forms of periodontal disease.  The most common ones include:

  • Gingivitis.  This is the mildest form of periodontal disease, causing the gums to become red, swollen, and to bleed easily.  There is usually little or no discomfort at this stage.  Gingivitis is reversible with professional treatment and good home care.
  • Aggressive Periodontitis.  This is a form of periodontitis that occurs in patients who are otherwise clinically healthy.  Common features include rapid attachment loss, bone destruction and familial aggregation.
  • Chronic Periodontitis.  This form of periodontal disease results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gum.  It is recognized as the most frequently occurring form of periodontitis.  While prevalent in adults, it can occur at any age.  Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
  • Periodontitis as a Manifestation of Systemic Diseases.  Periodontitis, often with onset at a young age, is associated with one of several systemic diseases, such as diabetes.
  • Necrotizing Periodontal Diseases.  This is characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone.  These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.

Causes and Development

Causes of Periodontal Disease:

  • Plaque.  The main cause of periodontal disease is bacterial plaque.
  • Genetics.  Research shows that up to 30% of the population may be genetically susceptible to gum disease.  Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease.
  • Other systemic diseases.  Diseases that interfere with the body's immune system may worsen the condition of the gums.

Signs and Symptoms

Healthy gums should look pink and firm with uniform color, not pale (anemic), red and swollen, or patchy/spotted.

Periodontal disease can affect one tooth or many and begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.  In the mildest form of the disease – gingivitis – the gums redden, swell and bleed easily.

Pain is usually not a symptom, which partly explains why the disease may become advanced before treatment is sought and why some patients avoid treatment even after periodontitis is diagnosed.

With time, plaque can spread and grow below the gum line and untreated gingivitis can advance to periodontitis.  Toxins produced by the bacteria in plaque irritate the gums.  The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself: the tissues and bone that support the teeth are broken down and destroyed.  Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected.  As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.  Often, this destructive process has very mild symptoms but eventually teeth can become loose and may have to be removed.

Gum Bleeding. Bleeding of the gums, even during brushing, is a sign of inflammation and the major marker of periodontal disease.  One exception is juvenile periodontitis, in which symptoms are mild or even absent.  It should be noted that the gums of smokers with periodontal disease tend to bleed less than nonsmokers.

Bad Breath. Debris and bacteria can cause a bad taste in the mouth and persistent bad breath.

Gum Recession and Loose Teeth. As the disease advances the gums recede, and supporting structure of bone is lost.  Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures.

Abscesses. Deepening periodontal pockets between the gums and bone can become blocked by tartar or food particles.  The infection fighting white blood cells become trapped and die.  Pus forms and an abscess develops.  Abscesses can destroy both gum and tooth tissue, cause nearby teeth to become loose and painful, and may cause fever and swollen lymph nodes.

Treatment and Prevention

Visit your dentist regularly (once every 6 months is recommended) so that if you do develop gum disease, it can be treated early on.

Signs, symptoms & indicators of Periodontal Disease - Gingivitis:

Symptoms - Head - Mouth/Oral

Gums that bleed/gums that bleed very easily

Bleeding gums are nearly always a symptom of gingivitis.

Conditions that suggest Periodontal Disease - Gingivitis:

Dental

Risk factors for Periodontal Disease - Gingivitis:

Addictions

Cigarette Smoke Damage

Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease [Journal of Periodontology, May 2000].  Put simply, smokers' teeth fall out faster than those of non-smokers.

A 2013 study published in the Journal of the American Dental Association found that postmenopausal women who smoked were much more likely to experience tooth loss than women who didn't.  Women who smoked two or more packs per day and women with the heaviest pack-years of smoking increased their chances of losing a tooth due to periodontal disease (PD) by 7 to 10 times.  Some of the substances in tobacco reduce the body's ability to fight infections such as PD, and both smoking and PD contribute to bone loss: The weaker your jawbone, which supports and anchors teeth, the more likely your teeth will loosen and even fall out.

Circulation

Coronary Disease / Heart Attack

Some studies show that people with gum disease are more likely have heart disease than those with healthy gums.  In 2012, a scientific statement from the American Heart Association supported an association between heart disease and gum disease.

Periodontitis is a serious gum infection that damages the gums and can destroy the jawbone.  It can also lead to an increase in inflammation across the body; overactivity of inflammatory pathways is a strong risk factor for the development of atherosclerotic heart disease and heart attack.

Dental

Bruxism (Clenching/Grinding Teeth)

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed.

Dry Mouth

Saliva helps fight the bacteria that cause gum disease and tooth decay.

Diet

Mental

Stress

Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal disease.  [Journal of Periodontology July 1999]

Organ Health

Diabetes Type II

If you are diabetic, you are at higher risk of developing infections, including periodontal diseases.  These infections can in turn impair the body's ability to process and/or utilize insulin, creating a vicious circle in which your diabetes may be more difficult to control and your infection more severe than in a non-diabetic.  [Journal of Periodontology November 1999]

Reproductive

Pregnancy-Related Issues

Pregnant women with periodontal disease are statistically more likely to have a baby that is born prematurely, according to a study of more than 2,000 pregnant women.  This connection is not yet fully understood but may be due to underlying inflammation or infections.

Conversely, pregnancy and its related hormonal changes appear to worsen gum disease and tooth loss.  During pregnancy the body experiences hormonal changes that can affect many tissues, including the gums.  Gums can become sensitive and at times react strongly to the hormonal fluctuations, which may in turn increase the susceptibility to gum disease.

Symptoms - Head - Mouth/Oral

One loose tooth or a few loose teeth

As gingivitis progresses, the gums recede and bacteria break down the supporting structure of bone.  Teeth loosen, sometimes causing a change in the way the upper and lower teeth fit together when biting down or a change in the fit of partial dentures.

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Periodontal Disease - Gingivitis suggests the following may be present:

Dental

Bruxism (Clenching/Grinding Teeth)

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and speed up the rate at which these periodontal tissues are destroyed.

Recommendations for Periodontal Disease - Gingivitis:

Botanical

Neem

Neem is a most effective gum disease treatment.  In a German study of 70 patients with pyorrhea of varying stages, after just 5 to 10 treatments with a neem-based toothpaste and mouthwash there was significant improvement.  Bleeding gums had healed and the secretion from pockets around the teeth had stopped.  The bluish-colored gums returned to a healthy pale pink color.  [Zeppenfeldt, undated].

Neem bark extracts can reduce the ability of some streptococci to colonize tooth surfaces [Wolinsky and Mania, 1996; Patel and Venkatakrishna, 1988].  Gingivitis has been prevented or even reversed with regular use of neem toothpaste and mouthwash [Elvin-Lewis, 1980].

One patient even reported a reversal of the loss of gum tissue by chewing fresh neem leaves.  Scientists believe that antibacterial compounds and neem's ability to improve the immune response in the gums and tissues of the mouth account for these results.

Oil of Oregano

Dilute oregano oil in a small amount of water and dab onto the affected tissues 3-4 times per day to kill the bacteria causing inflammation.

Dental

Adequate Dental Care

Gingivitis is often caused by inadequate oral hygiene and is reversible through professional cleaning to remove calculus and good oral home care to remove plaque and prevent the buildup of calculus.

Drug

Conventional Drug Avoidance

Some drugs, such as oral contraceptives, anti-depressants and certain heart medicines, can affect your oral health.

Surgery/Invasive

Surgery

Your periodontist may recommend periodontal surgery.  This is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired by non-surgical means.  Special deep cleaning procedures may prevent the need for surgery.

Preventive measures against Periodontal Disease - Gingivitis:

Diet

Sugar Avoidance / Reduction

The bacteria that come together to become plaque use sugar as a form of energy.  They multiply faster and the plaque grows in size and thickness.  Some of the bacteria turn sugar into a kind of glue and use it to stick themselves to the surface of the teeth.  This makes it harder for the bacteria to get washed away by saliva.

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