Gum Health ~ Gingivitis vs Periodontitis

If you’ve read the blog posts Healthy Mouth, Healthy Body and Nutrition for Dental Health you’ll have some idea of the importance of dental and gum health to prevent systemic and chronic diseases.

In this blog post we’ll look at the impact of gum disease on health and how to treat or prevent it. Gingivitis and periodontitis are types of gum disease that involve inflammation of the gums and tissues surrounding the teeth. Gum disease is also known as periodontal disease.

• Gingivitis is the early form of gum disease characterized by redness, swelling of the gums, bleeding gums, bad breath, receding gums and tender gums. Gingivitis is a reversible condition. It can usually be managed by professional teeth cleaning and oral care at home.
• Periodontitis is the advanced stage of gum disease. If gingivitis is left untreated, the infection may spread to the tooth-supporting tissues, causing periodontitis. It is characterized by periodontal pockets, dental abscesses, loose teeth, pain when chewing, persistent bad breath, receding gums and even tooth loss. Periodontitis can cause permanent damage.

Gingivitis and periodontitis are caused by bacteria that provoke a local inflammatory response. Plaque bacteria decompose carbohydrates in food and produce acids. These bacterial acids irritate the gums, causing gingivitis. Studies have found a strong association between periodontitis and some systemic diseases, including cardiovascular diseases, diabetes, lung diseases and complications of pregnancy (1).

Risk Factors

Periodontal health is influenced by a number of factors including:

• Poor oral hygiene: if you don’t brush your teeth regularly, plaque and food debris will accumulate on teeth surfaces. This provides a breeding ground for bacteria.
• Sugary foods and drinks: bacteria consume carbohydrates in food, and produce acids that irritate gums.
• Poor nutrition: a diet that lacks certain nutrients can increase the risk of gingivitis and periodontitis. Vitamins such as vitamin-C are essential for oral health.
• Dental caries and broken fillings: can allow plaque and food particles to accumulate between teeth, causing inflammation of the gums.
• Braces: food particles and plaque can become trapped in the space between braces and teeth, allowing bacteria to grow.
• Pregnancy: hormonal changes during pregnancy can increase the risk of gingivitis and periodontitis.
• Smoking: tobacco chewing and smoking weaken your immune system, and make it harder for your body to fight infection. Smoking also contributes to dry mouth conditions.
• Dry mouth: saliva plays an important role in oral health, fighting bacteria and neutralising acids. A decrease in saliva can increase your risk of caries, gingivitis, and periodontitis.
• Age: the risk of periodontitis increases with age.
• Certain medications: including oral contraceptives, steroids, anticonvulsants, calcium channel blockers, and chemotherapy may trigger the development of gingivitis and periodontitis
• Some medical conditions: systemic disorders and diseases can weaken your immune system, making it harder for your mouth to fight infection.

The Importance of Tooth Brushing

Tooth brushing aims to remove dental plaque from the teeth. Plaque is a sticky accumulation of bacteria, fungi and viruses known as a microbial biofilm that can be removed by brushing. Plaque biofilms re-grow on our teeth within a few hours of brushing. Not brushing teeth properly or for long enough can lead to higher levels of plaque, which may ultimately activate our body’s immune response, eventually leading to inflammation and gingivitis.

Proper technique

Current evidence suggests that brushing for up to 4 minutes each time you brush leads to cleaner teeth. It’s recommended to brush twice a day and to avoid using abrasive toothbrushes and toothpastes as these may damage the teeth and gums. One of the most often recommended tooth brushing methods is the modified Bass technique which involves brushing downwards from the gum line.

If plaque is not removed regularly, it can harden into tartar. In this case, you will need to visit your dentist to remove the tartar because it can’t be removed by tooth brushing or flossing.

As well as toothbrushing a saltwater rinse may help: put ½ teaspoon of salt in a cup of warm water and mix well. Swill this round the mouth for a minute before spitting it out. This may reduce inflammation, ease pain, and reduce bacteria. Alternatively use an antibacterial mouthwash.

Other top tips for gum and tooth health include:

• Avoid sugar and refined carbohydrates
• Avoid acidic foods and drinks such as orange juice, many soft drinks, citrus fruits etc.
• Avoid tobacco and alcohol
• Manage stress
• Check your medications – certain medications, such as some antidepressants and drugs for hypertension, may lower saliva production, which can increase your risk of gum disease. If you need to take these medicines there are special gels and sprays available that increase saliva production.

References

1. 2020 Sep 6;12(9):2724. The Impact of Diet, Nutrition and Nutraceuticals on Oral and Periodontal Health. Isola G.