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The Truth About Gingivitis


Gingivitis is the mildest and most common of the various types of periodontal, or gum, diseases. Its definition is simply--as its name implies--inflammation of the gingiva. Gingivitis is so common that virtually everyone has, at one time or another, experienced some degree of gingivitis.

Gingivitis is a nondestructive disease that is readily reversible, so if it is not allowed to exist for long periods of time, it is usually of little consequence. However, it is not completely innocuous. It can and usually does, if left unchecked, lead to a more severe type of periodontal disease called periodontitis. For this reason, patients should do their utmost to eliminate and prevent the recurrence of gingivitis.

Gingivitis Versus Periodontitis

Gingivitis is generally asymptomatic but is easily detectable because of its signs and symptoms. These include a shiny redness and swelling or puffiness of the gums, and a tendency for the gums to bleed easily while brushing or flossing. Patients with gingivitis can also display bad breath, or halitosis.

While gingivitis is reversible and does not cause loss of supporting bone and periodontal attachment, periodontitis does, by definition, result in bone loss around teeth and is irreversible in nature. Gingivitis does not cause periodontitis, but it is considered a precursor to it. That is, it can progress to the more severe form of gum disease. One way of describing the relationship between the two diseases is that while all gingivitis does not become periodontitis, all periodontitis starts as gingivitis.

Plaque-induced gingivitis is the most common of all periodontal diseases and the easiest to control, but it can be a precursor for more serious forms of gum disease.

What Causes Gingivitis?

Gingivitis is more properly termed "plaque-induced gingivitis." It is called this, since the sole cause of this condition is bacterial plaque. This sticky, bacteria-laden, colorless film starts to form around and between every tooth almost immediately after it is brushed and flossed.

After this bacterial plaque attaches to the tooth structure near the gingival soft tissue, the toxins excreted by the bacteria irritate the gingiva, causing it to become inflamed. Once this occurs, the patient is said to have gingivitis.

If this plaque is left in place long enough, it gradually starts to extend down below the gum line into the crevice or sulcus that extends between the gum tissue and the tooth. At the same time, this plaque matures and becomes populated with a more virulent and pathogenic form of bacteria. In time, it will become calcified into a material known as dental calculus. It is the calculus, populated with highly pathogenic bacteria and extending deep into the sulcus that eventually causes destructive and nonreversible periodontitis.

While the presence of bacterial plaque--i.e. the lack of good oral hygiene--is, for all practical purposes, the sole cause of plaque-induced gingivitis, the immunological response each individual patient has to the irritating nature of plaque is what causes the symptoms.

This response, sometimes called the "host response," can differ significantly between different individuals. That is, some people have a more exaggerated reaction to dental plaque byproducts than others and will more quickly develop a more severe case of gingivitis.

Certain factors can affect the degree of a patient's gingival response to bacterial plaque. These factors are not causative, in themselves, but rather are considered modifying factors. They include smoking, stress, pregnancy, menstruation, puberty, oral contraceptives, certain drugs, certain systemic diseases and conditions, and inadequate nutrition--especially vitamin C deficiency. Patients having one or more of these factors will therefore, in the presence of bacterial plaque, exhibit an enhanced display of gingivitis.

How to Prevent and Treat Gingivitis

The method for preventing gingivitis is the same as the method for eliminating it: the complete removal of all bacterial plaque from around and between the teeth. It is a simple, straightforward, and predictable course of action but one that is not always so easy to achieve.

Most people can accomplish this goal with the proper daily use of a soft-bristled toothbrush and dental floss. For additional help, they can employ the use of disclosing solution or disclosing tablets, which they can buy in drug and grocery stores. These products are designed to stain the normally colorless plaque sticking to the teeth a bright red color. Patients can disclose their teeth before brushing and flossing to reveal areas of plaque that they need to remove. They can then disclose again after cleaning their teeth and see any plaque that they might have missed.

There is general agreement that most patients can accomplish complete plaque removal using a manual toothbrush. However, some research has found powered toothbrushes to be more effective at removing plaque. This is especially so in patients with limited dexterity because of arthritis or some other disability. For these patients, a powered toothbrush is highly recommended.

Use of dental floss is essential in removing bacterial plaque from in between teeth, but it can be manually difficult for some patients to use. They might find that floss holders can make flossing in posterior areas easier. Other oral hygiene aids, such as interdental picks and interproximal brushes, can also help patients clean more thoroughly between the teeth. In addition, there is some evidence to indicate that mouth rinses and oral irrigation can help with plaque removal.

Patients must discover for themselves which oral hygiene methods work best for them. After that, it is simply a matter of practicing good daily oral hygiene. Those who can do that may never have to face the prospect of suffering from gingivitis or periodontal disease. Those patients who are susceptible to gingivitis and who find it difficult to keep it under control are advised to consult with their dentist or dental hygienist. They can help them achieve their goal of complete plaque removal.

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