Gingivitis is an inflammation of the gums surrounding the teeth. Gingivitis is one of many periodontal diseases that affect the health of the periodontium (those tissues that surround the teeth and include the gums, soft tissues, and bone). Chronic gingivitis leads to receding gums and can cause permanent damage to teeth. Gingivitis is a common cause of gum disease and a form of periodontitis.
Periodontal diseases are often classified according to their severity. They range from mild gingivitis, to more severe periodontitis, and more uncommon but serious acute necrotizing ulcerative gingivitis, which can be life-threatening.
Bacteria can cause inflammation of the gums. Although bacteria are normally found in our bodies and provide protective effects most of the time, bacteria can be harmful. The mouth is an ideal place for bacteria to live. The warm, moist environment and constant food supply are everything bacteria need to thrive. If not for a healthy immune system, bacteria in the mouth would rapidly reproduce out of control, overwhelming the body's defense system.
An infection begins when the body's immune system is overwhelmed. Gingivitis is an infection that occurs when bacteria invade soft tissues, bone, and other places that bacteria should not be. At the moment of infection, bacteria no longer help us, they begin to harm us. Infections, like other diseases, range from mild to severe or life-threatening.
Gingivitis Causes
Gingivitis is considered to be a bacterial infection of the gums. The exact reason why gingivitis develops has not been proven, but several theories exist.
For gingivitis to develop, plaque must accumulate in the areas between the teeth. This plaque contains large numbers of bacteria thought to be responsible for gingivitis. But it is not simply plaque that causes gingivitis. Almost everyone has plaque on their teeth, but only a few develop gingivitis.
It is usually necessary for the person to have an underlying illness or take a particular medication that renders their immune system susceptible to gingivitis. For example, people with leukemia and Wegener's granulomatosis can have changes in the blood vessels of their gums that allow gingivitis to develop. Other people with diabetes, Addison disease, HIV, and other immune system diseases have weaker ability to fight bacteria invading the gums. Persons with Sjögren's syndrome have chronic dryness of the mouth that predisposes them to develop gingivitis.
Sometimes hormonal changes in the body during pregnancy, puberty, and steroid therapy leave the gums vulnerable to bacterial infection.
A number of medications used for seizures, high blood pressure, and organ transplants can suppress the immune system and change the structure of the gums enough to permit bacterial infection.
Gingivitis Symptoms
Swelling, redness, pain, and bleeding of the gums are signs of gingivitis.
The breath begins to take on a foul odor.
The gums begin to lose their normal structure and color. The gums, which were once strong and pink, begin to recede away from the teeth and take on a beefy red, inflamed color.
Inflammation is a complex system by which bacteria-fighting cells of the body are recruited to an area of bacterial infection. Inflammation plays a major role in gingivitis. It is this inflammation of the gums that accounts for most of the symptoms of gingivitis.
When bacteria first begin to invade the gums, proteins present in the saliva and soft tissues called antibodies coat the bacteria and weaken it, making it an easy target for the body's immune system. The cells that encounter the bacteria first attempt to kill it and, in the meantime, release chemicals into the bloodstream to call other cells to their aid.
One particular cell called a macrophage is responsible for ingesting the bacteria and dissolving them with chemicals. This system works nicely, but it is not terribly efficient. While the invading bacteria are destroyed, chemicals used by the immune system cells to kill them are spilled into the surrounding tissues. This not only kills the bacteria but damages the nearby connective tissues and cells of the gums as well.
The body sees this inflammation as a small price to pay for stopping the bacteria. This process will continue until the source of the infection is removed.
When to Seek Medical Care
For simple gingivitis, work with your dentist. A concerted effort between good home dental hygiene, including regular and correct brushing and flossing, and regular dental visits should be all that is required to treat and prevent gingivitis. Home remedies are key. If gingivitis continues despite the effort to prevent it, contact your doctor to investigate the possibility of an underlying illness.
Gingivitis can usually be managed at home with good dental hygiene. If gingivitis turns into the most severe periodontal infection, acute necrotizing ulcerative gingivitis (ANUG), commonly referred to as trench mouth, treatment at a hospital may be required.
ANUG not only affects the gums but may spread to adjacent tissues of the face, neck, and bone. Bleeding, loss of periodontal architecture, and pain all characterize ANUG. The breath takes on a fetid odor, the teeth become loose, and the lymph nodes of the neck are often swollen. People with ANUG often have fever and complain of a generalized weakness reflecting widespread infection.
Like gingivitis, ANUG usually affects people with underlying conditions that can weaken the immune system such as malnutrition, HIV, or cancer. Therapy involves getting rid of the oral bacteria with antibacterial mouthwashes, oral antibiotics, periodontal treatment, and treatment of the underlying illness.
Gingivitis Diagnosis
Gingivitis is a clinical diagnosis. This means that the physician or dentist can arrive at the diagnosis by listening to the person's medical and dental history and performing a good oral exam. Blood work, X-rays, and tissue samples may be checked for cases not responding to initial therapy. The person should, however, be evaluated for underlying disease.
Gingivitis Treatment
Gingivitis Self-Care at Home
The best home care for gingivitis is prevention.
Regular dental visits to remove plaque buildup are necessary to combat gingivitis.
Once a dentist removes plaque, regular brushing and flossing will minimize plaque formation. Even with good dental hygiene, plaque will begin to accumulate again.
Gingivitis Medical Treatment
Removing the source of the infection is primarily how simple gingivitis is treated.
By brushing teeth regularly with a toothbrush and fluoride toothpaste approved by dentists, plaque buildup can be kept to a minimum.
Flossing is another means of removing plaque in between teeth and other areas hard to reach.
Regular checkups with a dentist are also important. A dentist is able to remove plaque that is too dense to be removed by a toothbrush or dental floss.
Severe gingivitis may require antibiotics and consultation with a physician. Antibiotics are medications used to help the body's immune system fight bacterial infection and have been shown to reduce plaque. By reducing plaque, bacteria can be kept to a level manageable by the human immune system. Taking antibiotics is not without risks and should only be done after consultation with a dentist or doctor.