Gingivitis & Gum Disease


Gingivitis (inflamed and bleeding gums) is common, but not normal. Classical signs of gingivitis include:

  • Swelling of the gums
  • The gums look red (instead of having a pink color).
    Please, observe that a smoker with severe gingivitis, will show all the classical signs of inflammation with one exception, the gums will still look pale; none or very little inflammation (redness) of the gums will be seen.
  • The gums bleed when you brush your teeth. In severe cases, even chewing of food might cause bleeding from the gums.
  • Pain or discomfort from the gums, especially when brushing.

The most common cause of gingivitis is poor oral hygiene. Good oral hygiene, on the other hand, such as daily brushing (at least morning & evening) and flossing (at least once a day; preferably at night, after the brushing), prevents gingivitis.

In the absence of treatment, gingivitis may progress to periodontitis (periodontal disease), where bacteria break down the bone, which support the teeth. For optimal oral health, a team approach is required, involving the dentist but even more so the patient.

Periodontitis (gum disease)

Left untreated, gingivitis can progress to periodontitis (gum disease), which by its nature is destructive to the bone around the teeth, thereby, loosening the teeth. In severe cases, teeth can actually fall out, as there is no bone left holding them.

Gum disease (periodontal disease) is the major cause for losing teeth in adults. Typical symptoms of periodontal disease are:

  • Dark red gums
  • Bleeding of the gums
  • Soreness in the gums
  • Swelling of the gums
  • Pus around teeth
  • Spaces appearing between teeth
  • Receding gums
  • Persistent bad breath
  • Sore teeth when chewing

It is also possible to have gum disease with no symptoms, which is why regular dental appointments with X-rays are necessary.

Bad Breath

Halitosis or bad breath occurs when noticeably unpleasant odors are exhaled in breathing. In most cases (80–90%), bad breath originates in the mouth itself. The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, and cheese). Bad breath may be transient, often disappearing after eating, brushing of teeth, flossing, or rinsing with a mouthwash. Bad breath that is more persistent (chronic bad breath) is a more serious condition.

Bad Breath

A common location for mouth related halitosis is the tongue. Large quantities of naturally-occurring bacteria are often found on the far back portion of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and provides an ideal environment for anaerobic bacteria (bacteria that does not require oxygen for growth), which flourish under a continually forming coating of food debris, dead epithelial cells, postnasal drip and overlying bacteria. When left on the tongue, the anaerobic respiration of such bacteria can produce volatile sulfur compounds, with a smell of rotten eggs. Therefore, in order to prevent bad breath from occurring and to treat existing bad breath, it is also important to clean the tongue.

In order to prevent the production of the sulfur-containing compounds, the bacteria on the tongue must be removed, as must the food debris present on the back portion of the tongue. This can be done either with a tooth brush or with a tongue scraper. Gently cleaning the tongue surface twice daily to remove the bacterial bio-film, debris, and mucus is an effective way to keep bad breath under control.

Advanced periodontal disease is a common cause of severe halitosis. Waste products from the anaerobic bacteria growing sub-gingival (below the gum margin) have a foul smell and have been clinically demonstrated to produce a very intense bad breath. Removal of the sub-gingival calculus (tartar) and inflammatory tissue has been shown to reduce mouth odor considerably.

Another source of bad breath is the nose. In this case, the air exiting the nostrils has a strong odor that differs from the oral odor. Nasal odor may be due to a sinus infection.

Maintaining proper oral hygiene should include daily tongue cleaning, brushing, flossing, and periodic visits to a dentist or a hygienist. Flossing is particularly important in removing food debris and bacterial plaque from between the teeth, especially at the gum-line. If you have dentures or other removable appliance, such as a removable retainer or a night guard, make sure that you clean the appliance thoroughly before placing it back in your mouth. At night, after cleaning your dentures you should soak them overnight in antibacterial solution.

During the more acute phase of the treatment of bad breath, an antiseptic mouthwash could be added to your routine. Mouthwashes often contain antibacterial agents such as chlorhexidine and zinc gluconate. Prolonged use of a mouthwash containing chlorhexidine though, can cause staining of the teeth and a darkish staining of the tongue.

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