Gum Disease – Gingivitis

If your gums are swollen, tender and bleed easily when you brush your teeth, you’re not alone. Nearly 80% of American adults have some form of gum (periodontal) disease. One of the most common of these is gingivitis, which develops when bacteria build up between your teeth and gums, leading to irritation, inflammation and bleeding. If not treated, it can progress to more serious gum diseases such as periodontitis and eventually to the destruction of bone and tooth loss.

Gingivitis is both preventable and treatable. Although factors such as medications and lowered immunity make you more susceptible to gingivitis, the most common cause is poor oral hygiene. Daily brushing, flossing and regular professional cleanings can significantly reduce your risk of developing this potentially serious condition. If you already have gingivitis, professional cleaning can reverse the damage.

Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you’re likely to have warning signs such as:

• Swollen, soft, red gums.

• Gums that bleed easily, even if they’re not sore.

• Many first detect a change in their gums when they notice the bristles of their toothbrush are pink, a sign gums are bleeding with just slight pressure.

• A change in the color of your gums from a healthy pink to dusky red.

Causes

Gingivitis begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it reforms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gum line into tartar (calculus), a white substance that makes plaque more difficult to remove and acts as a reservoir for bacteria. What’s more, you usually can’t get rid of tartar by brushing and flossing; you’ll need a professional cleaning to remove it.

The longer plaque and tartar remain, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

Although plaque is by far the most common cause of gingivitis, other factors can contribute to or aggravate the condition, including:

• Drugs. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body’s production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means plaque and tartar can build up more easily.

• Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.

• Viral and fungal infections. Although bacteria are responsible for most cases of gingivitis, viral and fungal infections also can affect your gums. Acute herpetic gingivostomatitis, for instance, is an infection caused by the herpes virus that frequently leads to gum inflammation and to small, painful sores throughout your mouth. Oral thrush, which results when a fungus normally found in your mouth grows out of control, causes creamy white lesions on your tongue and inner cheeks. Sometimes these spread to the roof of your mouth, your tonsils and your gums.

Other diseases and conditions. Some health problems not directly associated with your mouth can still affect your gums. People with leukemia may develop gingivitis when leukemic cells invade their gum tissue, for example. Other conditions, such as oral lichus planus, a chronic inflammatory disease, and the rare, autoimmune skin diseases pemphigus and pemphigoid can cause gums to become so severely inflamed that they may peel away from the underlying tissue.

• Hormonal changes. During pregnancy, gums are more susceptible to damaging effects of plaque. The problem is compounded if you have morning sickness — nausea and vomiting may make it hard to brush teeth regularly.

• Poor nutrition. A poor diet, deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. The recommended daily allowance for most adults is 1,200 milligrams a day — 1,500 milligrams if you are pregnant or are a postmenopausal woman not currently using HRT. Vitamin C helps maintain the integrity of connective tissue. It’s also a powerful antioxidant that counters tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body. Although many fruits and vegetables are rich in vitamin C, you may have low levels of this vitamin if you smoke, you eat a limited diet, or you have an eating disorder such as anorexia nervosa. Infants fed only cow’s milk or unfortified formulas are also likely to be deficient in vitamin C

Risk factors

Although anyone can develop gingivitis, many first experience gum problems during puberty and then in varying degrees throughout life. The most common contributing factor is lack of proper oral hygiene, but other factors also can increase your risk, including:

• Diabetes. If you have diabetes, elevated blood sugar levels can damage many parts of your body and your mouth is no exception. Diabetes increases your risk of cavities, gingivitis, tooth loss and a variety of infections. It also makes it more likely you’ll have a dry mouth, which further increases your risk of gum disease.

• Decreased immunity. If you have a weakened immune system, you’re more susceptible to infections of all kinds, including gum infections.

Treatment

Your dentist may treat gingivitis in several ways, but the first step is to thoroughly clean your teeth, removing all traces of plaque and tartar — a procedure known as scaling. The cleaning may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup.

Gingivitis usually clears up after a professional cleaning as long as you continue to follow a program of good oral hygiene. At first your gums may bleed after brushing, but this usually lasts just a few days. If you persist, you should see pink, healthy gum tissue in a short time. You’ll need to practice good oral hygiene for life, however, so your gum problems don’t return. 

Prevention

The best way to prevent gingivitis means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.

In addition, follow these tips to keep your gums and your children’s gums healthy. Children as young as six can develop gingivitis.

Choose the right toothbrush. Select a toothbrush with soft, end-rounded or polished bristles — stiff or hard bristles are more likely to injure your gums. The size and shape of the brush should allow you to reach every tooth. Remember that only the tips of the brush do the cleaning so there’s no need to exert extra pressure. Replace your brush every 3 to 4 months or even more often. If the bristles are splayed, you’ve waited too long.

Some dentists recommend electric toothbrushes with rotating or vibrating bristles because they may be more effective at removing plaque and maintaining healthy gum tissue than manual brushes are.

Brush as if your teeth depended on it. Brushing doesn’t do much good if you don’t do it correctly. Here’s what works: To clean outer surfaces of your teeth and gums, use short, back-and-forth, and then up-and-down strokes. Use vertical strokes to clean inner surfaces. To clean the junction between your teeth and gums, hold your brush at a 45-degree angle to your teeth.

Floss. If you’re like most people, this is the part of oral care you tend to ignore. It’s true flossing is a tedious job, which may be why most dentists say their patients don’t floss regularly. There may be a good alternative for non-flossers. In separate studies published in the Journal of the American Dental Association and the American Journal of Dentistry, people who brushed, then rinsed their mouths with an antiseptic mouthwash showed the same improvements in gingivitis as people who brushed and flossed. Antiseptic mouthwashes work because they contain essential oils that get between teeth to kill germs that brushing misses. Still, most dentists say not to toss your floss. Mouthwash works best when combined with brushing and flossing.

And to make sure all the effort put into flossing is rewarded, be sure to do it correctly. Here’s the drill: Use about 18 inches of waxed or unwaxed floss. Hold the floss taut and bent around each tooth in a C shape, scraping up and down each side of each tooth. Each stroke should go slightly below your gum line until you feel resistance. Flossing removes plaque between your teeth and helps massage your gums.

Pay attention to the brushing action, not the type of toothpaste. Some toothpastes claim to remove plaque and tartar or kill the bacteria that cause plaque. The truth is all toothpastes, including natural ones without additives of any kind, remove plaque if you brush properly. And no product can remove tartar below your gum line, although anti-tartar or tartar control toothpastes can help prevent tartar from building up. The bottom line? When used properly, inexpensive fluoride toothpastes remove plaque just as thoroughly as specialty toothpastes — it’s the brushing action, not the toothpaste, that removes plaque.

In addition to daily brushing and flossing, see your dentist or hygienist for regular checkups and cleanings.

Complementary and alternative medicine

Because nutrition plays a major role in oral health, many complementary and alternative therapies focus on supplying your body with certain nutrients. Some of these include:

• Coenzyme Q 10 (Co Q10, ubiquinone). This substance, which occurs naturally in your body and in a wide variety of foods, plays a key role in the production of cellular energy. It’s also a powerful antioxidant more potent than vitamin C. Researchers have studied the potential effect of Co Q10 on a number of conditions, including Parkinson’s disease, Alzheimer’s, cancer, cardiovascular disease and periodontal disease. Among other findings, CQ 10 applied to pockets of diseased gum tissue appears to reduce infection, but no studies have measured the effectiveness of oral CQ 10. You can purchase CQ 10 supplements at natural foods stores and some pharmacies. Look for oil-based capsules, which are far better absorbed and utilized than dry capsules are.

• Vitamin C. A potent antioxidant and major player in the synthesis of collagen, vitamin C is essential for healthy gums. Many fruits and vegetables, including citrus fruits, berries, cantaloupe, broccoli and spinach, are rich sources of vitamin C, and most natural foods stores and pharmacies carry vitamin C supplements. Whether you get Vitamin C from food or supplements, many dentists suggest getting 1,000 to 3,000 milligrams of vitamin C a day to help treat and prevent periodontal disease.

• Grapefruit seed extract. This natural extract has proven antibiotic qualities. Some suggest adding a drop to your regular toothpaste every time you brush. Look for grapefruit seed extract in natural foods stores or online.

• Cranberries. They’re not just for Thanksgiving anymore. Long known as a treatment for urinary tract infections, cranberries and cranberry juice work by preventing bacteria from adhering to cells that line the bladder. Now it appears cranberries may also keep bacteria from sticking to your teeth and gums. Unfortunately, most cranberry products have sugar added, which can undo the beneficial dental effects. Look for products sweetened with other fruits or fruit juices rather than with sugar. Suggested dose, three ounces of juice or six cranberry tablets daily. If you have a tendency to kidney stones or are taking the blood thinner warfarin, talk with your doctor before starting on a cranberry regimen.

The Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 2,500 physicians and scientists and 42,000 allied health staff work at Mayo Clinic, with sites in Rochester, MN., Jacksonville, FL., Scottsdale/Phoenix, AZ. www.mayoclinic.com/health/gingivitis