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1 A mild form of gum disease with inflammation of the gum is called gingivitis. Gum disease is also known as periodontal disease. As gingivitis is usually very mild; many people may have it and not know. Gingivitis should be treated, because it can progress into serious gum disease. If a person's gums are red instead of pink, inflamed, swollen and bleed when they brush their teeth, they most likely have gingivitis. Gingivitis is mainly caused by inadequate oral hygiene - not brushing your teeth enough or properly, and not flossing. Plaque, a sticky substance made up of bacteria builds up in the teeth. The bacteria release toxins that irritate the gums. Most of us will have a mild case of gingivitis some time during our lifetime. According to Medilexicon's medical dictionary: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." Periodontitis is "1. Inflammation of the periodontium. 2. A chronic inflammatory disease of the periodontium occurring in response to bacterial plaque on the adjacent teeth; characterized by gingivitis, destruction of the alveolar bone and periodontal ligament, apical migration of the epithelial attachment resulting in the formation of periodontal pockets, and ultimately loosening and exfoliation of the teeth." What are the causes of gingivitis? Gingivitis always starts off with a build up of plaque - an invisible, sticky film made up mostly of bacteria. When starches and sugars in food interact with bacteria normally found in our mouths, plaque can form on our teeth. Brushing our teeth twice a day and flossing once a day removes 1 / 8

2 plaque. Plaque can re-form very quickly - within 24 hours of brushing your teeth. Plaque that remains in our mouths for longer than two or three days goes hard under the gum line, and forms tartar (calculus). Tartar makes plaque much harder to brush away and acts as an environment in which bacteria can thrive. It is not usually possible to remove tartar by just brushing or flossing. It can only be effectively removed by a dentist or dental hygienist using a technique called scaling, scale, or polish - the tartar is scraped away using a special instrument. If there are any marks or stains the teeth are then polished. If the plaque and tartar remain in the teeth, the gingiva (the gum) will become more irritated and inflamed. Eventually, the gums will be swollen and more likely to bleed. If tartar build-up continues the condition can progress to periodontitis. Gingivitis and periodontitis are typically caused by poor oral hygiene. What are the risk factors for gum disease? A risk factor is something which increases the probability of a disease or condition developing. For example, smoking increases the risk of developing lung cancer. Therefore, smoking is a risk factor for lung cancer. The following are known risk factors for gum disease: - A weakened immune system - Diabetes - Hormonal changes - Older age - Smoking - Some medications - Some viral and fungal infections - Substance abuse Risk factors for ANUG (acute necrotizing ulcerative gingivitis) include: - A weakened immune system - Malnutrition - Mental stress 2 / 8

3 - Poor oral hygiene - Smoking - Untreated gingivitis or periodontitis What are the signs and symptoms of gum disease or gingivitis? Normal gums should be firm and pinkish, and should not bleed when you brush your teeth normally. Healthy gums keep our teeth anchored into place securely. Gingivitis primarily affects the gums. Signs and symptoms include: - Painful or tender gums - Swelling in the gums - Soft gums - Gums become dusky red instead of healthy pink - Gums bleed after brushing or flossing teeth As gingivitis is often painless, an individual may have it and not know. The first sign may be when the toothbrush bristles go pink; a sign of bleeding gums. Patients who develop periodontitis may have the following signs and symptoms: - More intense pain than with gingivitis - More bleeding than with gingivitis - More swelling than with gingivitis - Halitosis (bad breath) - An unpleasant taste in the mouth - Gums ooze pus - Eating problems - Loosening of teeth - Teeth fall out - Abscesses ANUG (acute necrotizing ulcerative gingivitis) - symptoms are more intense and severe than with periodontitis or gingivitis, and may include: - Elevated body temperature - General malaise 3 / 8

4 - Very painful gums - Gums that bleed a lot (much more than with gingivitis or periodontitis) - Halitosis, which tends to be very strong - Excessive saliva production - Metallic taste in the mouth - Ulcers in between the teeth Diagnosing gingivitis In most cases the evident signs and symptoms are enough for a diagnosis of gingivitis to be made, without further tests. A GP (general practitioner, primary care physician) who suspects gingivitis will refer the patient to a dentist. - Periodontitis - as this type of gum disease requires a thorough dental examination, a doctor who suspects periodontitis will refer the patient to a dentist. The dentist may use a periodontal probe to measure the depth and groove between the patient's gums and teeth. The probe is placed under the gum line, next to the teeth. If the groove is deeper than it should be it is a sign of periodontitis. Sometimes the dentist may take an X-ray to see what state the patient's teeth and jaw bone are in. - ANUG (Acute necrotizing ulcerative gingivitis) - if a doctor suspects ANUG the patient will be referred to a dentist. A dentist can diagnose ANUG from the patient's signs and symptoms. As ANUG can trigger serious complications, it is important to see the dentist immediately. If the patient first sees a dentist, who diagnoses gingivitis, he/she may be referred to a doctor to find out whether there are any underlying medical conditions. What are the treatment options for gum disease? - A comprehensive cleaning of the teeth - all traces of plaque and tartar are removed (scaling). The procedure may be uncomfortable, especially if the patient's gums are sensitive, or if plaque and tartar build up is considerable. 4 / 8

5 - Antiseptic mouth rinse - this may be in the form of a spray or gel which is generally used for about a month. It helps clear away bacteria. The doctor may prescribe chlorhexidine or hexetidine. A wide range of antiseptic mouth rinses can be purchased OTC (over-the-counter, no prescription required). - Antibiotics - in some severe cases of periodontitis the dentist may prescribe a short course of antibiotics to help treat infection in the gums. Examples of medications commonly prescribed for this type of gum infection include metronidazole and doxycycline - they are usually taken three times daily for three days. Pregnant or breastfeeding women should not take doxycycline. Doxycycline can also interfere with the effectiveness of the contraceptive pill, so the patient should use an additional form of contraception, such as a condom during treatment and continue doing so until seven days after taking the last tablet. - Brushing teeth - the dentist will review the patient's tooth-brushing technique, and if necessary, explain how to do this properly. Many dentists say that an electric toothbrush helps guarantee good tooth-brushing. If fluoride levels in the tap water are low toothpaste with fluoride should be used. Fluoride helps strengthen tooth enamel, which protects it from decay. 5 / 8

6 - Flossing teeth - the dentist will review the patient's flossing technique, and if necessary, explain how to do this properly. - Fixing dental problems - if there are any misaligned teeth, poorly fitted crowns, bridges or other dental restorations, they will need to be fixed. Removing plaque and tartar when dental restorations are causing problems is more difficult. After professional cleaning gingivitis usually resolves itself; providing the patient pursues long-term good oral hygiene. The gums should return to their healthy pink color. - ANUG (Acute necrotizing ulcerative gingivitis) ANUG cannot be self-treated; the patient needs to be treated by a dentist. If the first visit was to a doctor, he/she may provide some treatment to tide the patient over until arriving at the dentist's. This may include: - Antibiotics - the most commonly antibiotics for the treatment of ANUG are metronidazole or amoxicillin. Patients who are allergic to penicillin should not take amoxicillin. Treatment usually lasts three days. Amoxicillin may interfere with the efficacy of the contraceptive pill; the patient should use additional contraceptive during treatment and for seven days afterwards. - Painkillers - these may include ibuprofen or Tylenol (paracetamol). Patients with asthma should not take ibuprofen. Children under sixteen should not take aspirin. 6 / 8

7 - Mouthwash - the patient uses them two or three times daily. Examples include chlorhexidine or hydrogenperoxide. Patients with ANUG should use a very soft toothbrush if they have painful ulcers, or if their gums are especially sensitive. Until the gums recover, those with ANUG should not use an electric toothbrush. If even a soft toothbrush causes too much pain, tell your dentist. Sometimes patients may be advised to clean their teeth with a finger covered in a soft cloth. Ask your dentist how to do this. What are the complications of gum disease? Untreated gingivitis can lead to periodontitis. Untreated periodontitis can lead to: - Recurring gum abscesses - Loose teeth - Loss of teeth - The alveolar and periodontal membrane can become damaged - bone and tissue surrounding the root of teeth can become damaged - Receding gums - Heart disease and stroke - people with recurring periodontitis are much more likely to have heart problems or suffer a stroke. Premature birth - a pregnant woman with periodontitis has a significantly higher risk of giving birth prematurely, compared to other women. ANUG (Acute necrotizing ulcerative gingivitis) Untreated ANUG can lead to infection throughout the gums and bones surrounding the teeth. 7 / 8

8 The gums between the teeth can become so damaged that teeth become loose and start falling out. Untreated ANUG can also lead to recurring ANUG. The patient will have frequent episodes of bleeding gums and halitosis (bad breath). Untreated ANUG can lead to gangrene - this is very rare. Affected tissue dies. Preventing gum disease - Proper oral hygiene - people who practice good oral hygiene are much less likely to develop gingivitis, periodontitis or ANUG. Good oral hygiene means brushing your teeth twice a day, ideally with an electric toothbrush, and flossing daily. - See your dentist regularly - people with good teeth who have never had gum disease should see their dentist at least once every two years. If you only see your dentist once every two years make sure you don't forget to go to that appointment. Some dentists say visits should be more frequent than this. People who have had gum diseases should see their dentist at least once a year. When your treatment is over ask your dentist when you should come back. Higher risk people may have to visit their dentist more frequently. If you have diabetes, smoke, or have a weakened immune system ask your dentist when you should come back. 8 / 8