GINGIVITIS - "Bleeding Gums"
My Periodontist Helps With Gingivitis, A Bleeding Gum

Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque. Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Periodontal diseases are often classified according to their severity. They range from mild gingivitis, to more severe periodontitis, and finally acute necrotizing ulcerative gingivitis.

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 a great 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

Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth. An infection begins when the body's immune system is overwhelmed.

Signs of Gingivitis
Swelling, redness, pain, and bleeding of the gums are signs of gingivitis. The breath begins to take on a foul odor. Gums that bleed easily, even if they're not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink - a sign that gums are bleeding with just slight pressure.

The gums begin to lose their normal structure and color. The gums, which were once strong and pink, may begin to recede and take on a beefy red, inflamed color.

Inflammation-a complex system by which bacteria-fighting cells of the body are recruited to an area of bacterial infection-plays a major role in gingivitis. It is this inflammation of the gums that accounts for most of the symptoms of gingivitis.

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.

Who's At Risk for Gingivitis?
Certain people are more susceptible to gingivitis. Stress, smoking and poor nutrition can contribute to the development of gingivitis. Certain medications such as steroids, heart medications, cancer therapy drugs and anti-epilepsy drugs can aggravate the inflamed gingival tissue.

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 re-forms quickly, usually starting within 2-4 hours.

Plaque that stays on your teeth longer than two or three days can harden into tartar (calculus), a white substance that makes plaque more difficult to remove and that 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 on your teeth, 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 that 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.

The swelling and redness of the gums may be disproportional to the amount of plaque present. To prevent further complications, meticulous plaque control is critical for people with these illnesses.

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

Poor nutrition. A poor diet, especially one 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 the 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 people 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 that 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.

When to seek medical advice
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, see your periodontist. The sooner you seek care, the better your chances of reversing damage and preventing more serious problems. Hopefully not, but Gingivitis can also be a symptom of something more serious going in your body and it may be of great wisdom to visit a medical doctor and get checked out.

Complications. Untreated gingivitis can progress to periodontitis, a much more serious form of gum disease. Periodontitis can cause tooth loss and may even increase your risk of heart attack and stroke. What's more, women with periodontitis are far more likely to give birth to premature babies than women with healthy gums are.

Gingivitis Treatment
Your periodontist 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 and root planing . This can involve re-shaping existing restorations or even moving teeth with braces so that they are not crowded. Essential to the success of the gingivitis treatment is the person's ability to control plaque build-up after initial treatment. Daily brushing and flossing are key to gingivitis prevention and helps prevent bad breath..

If there is a lot of gum inflammation, if the gums are very sensitive, or if there is a lot of tartar buildup, it may be necessary to numb the gums in order to remove the buildup of bacteria underneath the gum margins. Gingivitis usually clears up after a professional periodontal cleaning as long as you continue to follow a program of good oral hygiene at home. 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. Because misaligned teeth and poorly fitting crowns and bridges make it harder to remove plaque, your periodontist may recommend fixing these problems as well.

Gingivitis is reversible, and with proper gingivitis treatment and maintenance, it can be controlled. However, untreated gingivitis can result in gum defects, bone loss around the teeth, and eventual tooth loss and systemic complications. The best way to prevent gingivitis is by brushing and flossing daily, and by visiting the dentist for a routine cleaning and an examination at least every six months

Prevention
The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That 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 6 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. And electric brushes may be especially helpful for people with arthritis, Parkinson's disease or other problems that affect dexterity. But you don't have to invest a lot of money to achieve good oral health - a manual toothbrush used properly will give good results.

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 that 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 nonflossers. 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 that all the effort you put into flossing is rewarded, be sure you 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 gumline 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 to kill the bacteria that cause plaque. The truth is that all toothpastes, including natural ones without additives of any kind, remove plaque if you brush properly. And no product can remove tartar below your gumline, although anti-tartar or tartar control toothpastes can help prevent tartar from building up on your teeth. 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.

See your periodontist for a checkup or questions you might have. The periodontist specializes in the gums that support the teeth. They are foundation experts of the mouth and give you some great oral advice and help. If the gums, or foundation of your mouth has problems so will your teeth. In addition to daily brushing and flossing, see your dentist or hygienist for regular checkups and cleanings.