Gum Diseases (Gingivitis and Periodontitis)

Gum disease (Gingivitis and Periodontitis)

Gum disease is described as swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: gingivitis and periodontal disease.

Gingivitis-

Gingivitis refers to ‘inflammation of the gums'.Signs and Symptoms:

·       Colour- red

·       Contour- loss of stippling

·       Consistency- swollen (inflamed gums)

·       Pockets (gingival sulcus with a depth of more than 3mm)

Types of Gingivitis

Gingivitis can be classified according to distribution (localised, generalised, marginal) or duration (acute or chronic) or causes as follows: 

1.     Hormonal gingivitis, which includes pregnancy gingivitis and pubertal gingivitis

2.     Acute Necrotising Ulcerative Gingivitis (ANUG), caused by poor oral hygiene, stress and smoking. It is characterised by painful papillary, yellowish-white ulcers, which bleed easily.

3.     Drug-induced hyperplastic gingivitis, from long term use of anti-epileptics and certain antihypertensives

Periodontitis

Long-standing gingivitis can turn into periodontal disease. Inflammation of the periodontium, characterised by progressive loss of attachment and destruction of periodontal ligament and alveolar bone

Types

Periodontitis can be classified according to distribution (localised or generalised), onset (pre-pubertal periodontitis and juvenile periodontitis) or severity as:

1.     Mild Periodontitis: localised alveolar bone loss of 2mm or less, pocket depth of 3-5mm

2.     Moderate Periodontitis: alveolar bone loss of 3-5mm, pocket depth of 4-6mm, mobile teeth

3.     Advanced Periodontitis: major destruction of attachment and alveolar bone, with alveolar bone loss of more than 5mm, pocket depth exceeding 6mm and greater tooth mobility. 

The cause of gum disease

The main aetiological factor in most forms of periodontal disease is plaque, a firmly adherent mass of bacteria. Persistent plaque accumulation for more than 2 weeks, leads to formation of calculus (tartar), which consists mainly of mineralised, dead bacteria and a small amount of mineralised salivary proteins. Calculus formed above the gingival margin is called supragingival calculus, while that formed below the gingival margin is called subgingival calculus. Newly formed calculus is light yellow. It is easily stained dark by foods, tea and tobacco. Calculus is most frequently found close to the openings of the major salivary glands (at the lingual surface of the lower anterior teeth and at the buccal surface of the upper posterior teeth). Calculus cannot be removed by tooth brushing. Calculus is not a disease per se. However, its presence can make cleaning the teeth more difficult.

Recent studies show that periodontal disease is a complicated multi-factorial infection. It results from an imbalance between potentially pathogenic microbes and local and systemic host responses. In other words, bacteria is necessary but not sufficient to cause disease.

Effects of smoking on gums and teeth-

People who smoke are more likely to produce bacterial plaque. The gums are affected because smoking causes a reduced supply of oxygen in the bloodstream, so the infected gums don't heal. Smoking causes people to have the gum disease to get worse more quickly than in non-smokers.

Prevention

1.     Effective oral hygiene: brushing twice a day, after meals, with a fluoridated toothpaste, or use of chewing sticks in places where toothbrushes and toothpastes are unavailable or unaffordable.

2.     Avoiding risk behaviours like smoking

3.   Control of systemic diseases like diabetes

 Treatments of gum diseases

Scaling