If you find blood oozing from your mouth even during normal brushing or biting on an object, it can be an alarming sign of developing gum disease. Gum disease can be briefly classified into two categories as Gingivitis and periodontitis. Gingivitis is the milder form of gum disease whereas periodontitis is an advanced form. Gum diseases can make your teeth loose and can cause premature tooth loss.

Let us understand about the gum diseases, their signs and symptoms in detail and go through the available treatment modalities.

What causes of gum disease?

The primary causative factor of gum disease is improper oral hygiene. But certain other factors can also contribute to the development of gum diseases, gingivitis, and periodontitis.

  • Long-term deposition of plaque causes gingivitis
  • Uncontrolled diabetes contributes to periodontitis (1)
  • Systemic diseases, such as thyroid disorders, nutrient deficiencies or HIV infection can contribute to various gum diseases
  • Certain medications, including phenytoin, birth control pills can cause pseudo gingivitis
  • Misaligned teeth are difficult to clean, leading to gum diseases
  • Gum injury due to extremely vigorous brushing or flossing can develop gum inflammation
  • Ill-fitting crowns, bridges, and braces, or rough edges of fillings are also predisposing factors
  • Hormonal changes that occur during puberty and menopause
  • Changes in hormones can cause gum sensitivity; pregnant women sometimes get gingivitis which subsides post pregnancy (2)
  • Immunocompromised conditions, as in AIDS or cancer
  • Children who have leukemia, blood dyscrasias
  • Chronic debilitating disease
  • Habits such as smoking or chewing tobacco
  • Scurvy, due to vitamin C deficiency and pellagra caused due to niacin deficiency
  • Acute herpetic gingivostomatitis caused by the herpes virus
  • Fungal infections such as Candida albicans in the mouth, resulting in candidiasis or thrush may cause gingivitis (3)
  • Gingivitis may occur in the gums surrounding an impacted tooth. This condition, called pericoronitis is frequently seen with the wisdom teeth
  • Allergic reactions, heavy metal toxicity due to bismuth and lead
  • Ill-fitting or unclean mouth appliances and dentures

Who are at risk of developing gum diseases?

Apart from poor oral hygiene, various other factors can increase your risk of developing gum diseases. These include-

  • Gum disease is more common as you get older
  • Smoking and tobacco consumption (4)
  • A family history of gum disease
  • Diabetes is a predisposing factor for gum diseases
  • Weak immune system due to conditions such as AIDS or specific treatments, such as chemotherapy
  • Malnutrition and nutritional deficiency
  • Chronic stress

Types of gum diseases

Gum disease is any swelling, soreness or infection of the tissues which support the teeth. The two main categories of gum disease are gingivitis and periodontitis.

Gingivitis

Gingivitis is inflammation of the gums (5). In this, the gums around the teeth become red and swollen. Often the swollen gums bleed when during routine activities like brushing or biting on a portion of food.

The primary causative factor of gingivitis is poor oral hygiene, which causes plaque to build up on teeth. Plaque is a sticky substance which develops on the teeth when sugars in food interact with the normal mouth bacteria.

Plaque develops quickly, which is why it is essential to brush and floss every day to remove it. If not removed timely, it can turn into tartar, a hard deposit at the base of the tooth. Both plaque and tartar cause inflammation of gums and produce bacteria and toxins that cause gingivitis.

Sign of gingivitis

  • Pale pink color and firmness characterize healthy gums. Because gingivitis is usually not painful, many people do not realize it and ignore the signs.
  • Bleeding gums, even with gentle brushing or touching
  • Tender gums, especially when touched
  • Swollen gums with rolled out gum margins
  • Bright red, dusky red gums with a shiny appearance
  • Halitosis or bad breath
  • Mouth sores

Types of gingivitis

Chronic gingivitis

It occurs due to long-term inadequacy in maintaining oral hygiene. The gums bleed on a daily and are accompanied with halitosis.

Acute Necrotizing Ulcerative Gingivitis (ANUG)

The other form of gingivitis is known as acute necrotizing ulcerative gingivitis, Vincent’s stomatitis, or trench mouth (6). ANUG is rare and develops in a person with a severely impaired immune system or those with severe malnutrition.

This is an invasive form of gingivitis which may cause foul-smelling breath, fever and painful gums in addition to other symptoms.

Periodontitis

Periodontitis is a chronic infection which affects the gums and the bones supporting the teeth (7). Bacteria and their toxins and our immune system break down the bone and connective tissue that hold teeth in place. Teeth will eventually become loose, fall out, or have to be removed.

When gingivitis is not treated, it advances to periodontitis. The gums roll away from the teeth and form spaces called as pockets which harbor the plaque, tartar, and bacteria.

Our body’s immune system fights this bacteria as the plaque and tartar spreads and grows below the gum line. Bacterial toxins and our natural immune response to infection start to break down the bone and connective tissue.

This causes weakening of the tooth support. The teeth eventually become loose and have to be removed.

Signs of periodontitis

  • Pain when chewing
  • Poor tooth alignment
  • Mobility of teeth
  • Teeth changing its alignment
  • Receding Gums
  • Pockets between the teeth and gums
  • Persistent bad breath
  • Sores on the inside of the mouth
  • Loose or sensitive teeth

Types of periodontitis

There are many different types of periodontal disease affecting the tissues supporting the teeth.

Chronic periodontitis

It is the most common form of periodontitis and is characterized by the formation of pockets and gum recession.

Aggressive periodontitis

It is characterized by rapid loss of gums and bone destruction (8). It is rare and usually sets in at a young age. It can also be a manifestation of systemic diseases associated with diabetes, heart disease, or respiratory diseases.

Necrotizing periodontal disease

It is characterized by necrosis of gum tissue, periodontal ligaments, and alveolar bones, causing gum lesions. It is most common in people with HIV, malnutrition, and immunosuppression.

Treatment for gum disease

Scaling and polishing

This is the most routine dental procedure for ensuring adequate oral health. this is a prophylaxis measure wherein the plaque membrane and the tartar deposits are broken by the vibrations of ultrasonic scalers. The roughened tooth surface is then polished.

Tooth Scaling and Root Planing

This is a two-step procedure to treat periodontitis.  First the dental professional will scrape off the tartar buildup on teeth both above and below the gum line. Next, the roughness on the tooth roots will be smoothened, making it difficult for bacteria to collect and retain.

Flap surgery

If the gum inflammation and pockets persist even after a deep teeth-cleaning procedure, your dentist may recommend you a flap surgery. Flap surgery is a dental procedure to treat advanced periodontitis.

During flap surgery, the tartar deposits are removed from the pockets alongside the teeth by creating flaps of the gum and exposing the tooth root. The flaps are then closed with stitches.

Grafts

In cases of advanced periodontitis wherein the bone and tissue have been destroyed and infected, you may need bone or tissue grafts. In this procedure, a small piece of a mesh of the required component is placed between the jaw bone and gums to allow the growth of bone and tissue around it.

This process is called guided tissue regeneration. This procedure promotes the growth of bone through the use of a biocompatible fabric being placed between the bone and tooth.

The material also prevents unwanted tissue from growing so that the bone can develop around the tooth.

Doxycycline Gel

It contains doxycycline which is an antibiotic providing periodontal disease treatment by killing bacteria and shrinking the pockets. Your dental professional applies this gel to the pockets after the root planing procedure, and the antibiotic is gradually released over a period of about a week.

Chlorhexidine Chip

This involves placing a small antimicrobial gelatin chip in the pocket along the gum line after the root planing procedure, and the antimicrobial content is released gradually over time curbing the growth of the bacteria (9).

Enamel matrix derivative application

This procedure involves the use of a gel to a diseased tooth root. The gel contains the same proteins that naturally exist in developing tooth enamel. The application stimulates healthy bone and tissue growth (10).

Doxycycline Pill

Your dentist may prescribe you an antibiotic pill for periodontal disease treatment in addition to the tooth scaling and root planing. This low-dose doxycycline pill can help prevent overactive enzymes from breaking down gum tissue after periodontal disease treatment.

Final words

Prevention is best in case of any gum disease as it can irreversibly make your tooth weak. Smoking, use of other tobacco products can cause severe damage to gum tissue.

Also, avoid rigorous and harsh brushing and flossing. Brush gently twice daily with a soft to medium bristle toothbrush. Be regular with your dentist and get the regular tooth scaling procedure as recommended.

If you find blood oozing from your mouth even during normal brushing or biting on an object, it can be an alarming sign of developing gum disease. Gum disease can be briefly classified into two categories as Gingivitis and periodontitis. Signs of gingivitis are bad breath, tender gums, mouth sores, etc.