What Is Gingivitis
Most patients won’t have heard of this term, gingivitis, but everyone is aware of Gum Disease. Gum Disease is a general term and it refers to a number of different problems that can occur with gums. Gingivitis is simply one type of gum disease. There are other types of gum disease such as periodontitis and ANUG but in this article, I will be only talking about gingivitis.
Gums are really important because it is the gums that help to hold your teeth firmly in place. Once the gum becomes infected or diseased, your teeth can then become loose. However, before this happens, you will probably notice that your gums have started to shrink away or have started to recede. Your tooth or teeth may appear to become longer. Of course, your teeth can’t become longer. Instead, it is the gum recession that makes the teeth just appear longer.
Gingivitis is an early mild form of gum disease but I suppose the good thing about it is that it is reversible and its treatment is simple. If the gingivitis is treated in time, no permanent damage will have been caused to your gums. Gingivitis can be reversed by the correct treatment, very quickly. It only takes about a week for gingivitis to be eliminated. However, this is not the case with the other forms of gum disease. Other types of gum disease, can be more aggressive and cause damage which can’t be reversed. For example, periodontitis is a more difficult type of gum disease to treat. Treatments for periodontitis can take many visits over many weeks and in the end, it may still not work.
The proper scientific dental term for the gums is “gingivae” and in medicine, a word ending in -itis refers to inflammation, so gingivitis means an inflammation of the gums. When gums are inflamed, they become red, swollen, bleed easily and can be tender as well. The reason why they become this way is due to a substance called plaque. You may have heard of the word plaque but may not know what exactly it is.
Plaque
Everyone’s mouth contains millions and millions of bacteria. These bacteria are found everywhere including on the surface of your teeth where it is in the form of a sticky mesh like matrix. If you haven’t brushed your teeth for a while and you rub the edge of your fingernail on the surface of your teeth, you will notice that a white substance shows up on your nail. This white substance is called plaque. Because it is sticky, it can only be removed from your teeth by physically brushing it off twice a day. Rinsing your mouth with a mouthwash or water won’t get this plaque off your teeth. Plaque builds up on all surfaces of your tooth including areas in between your teeth where a toothbrush bristle can’t access. This is why you need to use floss or interdental brushes in addition to your normal brushing.
What does plaque do?
As mentioned before, plaque is made up of lots of bacteria to form a sticky mesh. The bacteria in the plaque produce chemicals which attack your gums causing gingivitis, ( red, swollen, bleeding and tender gums.)
If you are a patient who has gingivitis, the very first thing you will notice is that your gums bleed when you brush. Your toothbrush will have blood on it and when you spit the toothpaste out, it will have blood in it. As the gingivitis gets worse, even very gentle brushing with a soft brush will cause bleeding and biting into an apple will leave traces of blood. Eventually, your gums will bleed even by touching them with your finger in front of the mirror. Ironically, when patients notice bleeding gums, they actually stop brushing as hard or even stop brushing altogether. But this makes the problem much worse because the plaque build up even thicker which produces more of the inflammatory chemicals causing more attacks on your gums! The lesson here is that if your gums bleed, you should carry on brushing harder, for longer and more often.
What if the gingivitis is not treated?
When gingivitis is not treated, it may lead to a more severe form of gum disease called PERIODONTITIS. Periodontitis is the form of gum disease which is responsible for over 50% of all extractions. More teeth are lost from periodontitis than tooth decay.
Although nearly everyone will or has gingivitis already, making it the most common disease in the world, only about 10% of those will end up with the more severe form called periodontitis. The problem is that, not even a dentist can predict or find out which of those 10% will develop the more severe form of gum disease. That’s why, if you have red gums which are swollen, tender and look red, then you should get it looked at by a dentist before it is too late.
Are some patients more likely to develop gingivitis?
Yes, if you are a smoker or you are a diabetic.
Also, if you have lots of fillings or crowns which are rough or have overhangs. These make it more difficult to clean and therefore more plaque builds up, increasing the likehood of developing gingivitis.
Tartar build up also creates a rough surface which leads to more plaque accumulation. ( Tartar forms when plaque is not removed frequently and it then eventually becomes hard due to the soft plaque absorbing calcium from your saliva.) Tartar build up cannot be removed by a toothbrush and can only be cleaned off by going to see your dentist who uses a special machine called a scaler to clean this stuff off.
The tartar, rough fillings and crown overhangs are sometimes referred to as “ plaque retentive factors.”
How is gingivitis treated?
Gingivitis is treated by removing it’s MAIN cause which is plaque.
In addition, smokers can be offered “smoking cessation advice” and you can encourage diabetics to have their diabetes monitored so that is under control.
A dentist will also examine your teeth for “ plaque retentive factors” and remove or correct these accordingly. So if a filling is rough, it can be polished up to make it smoother. It then won’t attract as much plaque.
How is the plaque removed?
Because plaque is a sticky film that build up on the surfaces of your teeth, it must be removed physically or mechanically. This is done by brushing. Patients with gingivitis all say that they brush their teeth which may be true. The problem is that they are doing something wrong, otherwise the gingivitis would not exist. Things that they may be doing incorrectly can be:
- Using an old brush which is not doing its job anymore.
2. Using a soft brush which is not removing all the plaque.
3. Using an incorrect technique which is not removing all the plaque.
4. Not using interdental aids.
The spaces in between your teeth are called interdental spaces. A toothbrush bristle cannot reach these areas so interdental aids are also necessary. Examples of interdental aids are dental floss and interdental brushes or even cleaning sticks.
A dentist or a hygienist will give you the best advice on the above. Once, the plaque is being removed, it does not take long, for the inflamed gums to return to normal.
Healthy gums appear pink and don’t bleed when brushed.
By the way, if you have gingivitis and then you start to brush better, initially, your gums will bleed even more and will be even more tender. This is simply because of how inflamed they are but over a short period of time, the inflammation will reduce causing less bleeding and less tenderness.
Can mouthwashes get rid of gingivitis?
A mouthwash will not on its own be able to remove the plaque film off your teeth. Only brushing can physically remove plaque. However, once you have thoroughly cleaned every single last trace of plaque, a mouthwash can reduce the rate at which the plaque grows back on your teeth. Two such brands are Listerine and Corsodyl which don’t remove plaque but only help to reduce its formation. My personal viewpoint is that mouthwashes are not necessary and are only an expensive waste of money down the sink hole. Instead, just spend time and effort on brushing properly in the first place. A regular dental examination every 6 months by a dentist will identify early problems which will make sure you never get any gum disease, ever.
REFERENCES
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