The devastation of gum disease

A FEW weeks ago I extracted 14 teeth from a patient at one sitting and installed an immediate total denture. He literally walked into the clinic with a jaw filled with condemned teeth and left with a perfect denture installed. His problem was severe gum disease which is the most commonly devastating condition in dentistry.

And it all starts with gingivitis. This is the most common disease that involves the gum while caries is the most common affecting the teeth. Characterised by red or inflamed gum (gingival) tissue, it is experienced by just about everyone with teeth from time to time and in varying degrees. Sometimes the inflammation appears as a thin red or bluish red line – marginal gingivitis – around all or a few teeth. Depending on whether the condition is generalised or localised.

The most common cause of gingivitis is poor oral hygiene. If teeth are not brushed, gingivitis develops within a week as bacteria-infested plaque deposits from around and just beneath the gum. If there is gingivitis although the person has good oral hygiene then HIV infection should be investigated.

Some systemic diseases induce or exaggerate gingivitis. Spontaneous haemorrhaging may indicate a serious disease such as leukaemia. In fact, any disease that interferes with the blood’s normal clotting mechanism, including haemophilia, uremia, and liver disease, is likely to cause hemorrhagic gingivitis. These include taking drugs such as heparin sodium (heparin is a component of normal blood). Heart attack or stroke from clots forming in blood vessels narrowed by cholesterol deposits (a completely different type of plaque) can also cause bleeding of gums.

Many people with no heart disease take low doses of aspirin for its blood-thinning quality, which reduces the risk of heart attack. Millions of arthritis victims are on high doses of aspirin, which can also contribute to bleeding gums.

With chronic gingivitis, gums bleed easily to touch and pressure with little or no pain, although some patients complain of slight soreness. In more severe cases, gums bleed when eating as food presses against the tissue. The toothbrush and dental floss turn pink, and saliva and rinse water are red with blood as one spits out after brushing.
Early gingivitis can be cured by self-treatment thorough daily brushing and flossing to remove irritating food debris and soft plaque deposits.

A soft nylon brush should be directed at a 45-degree angle and jiggled in a massaging motion directly on the gum. Special rubber cup massagers are also available. If gums are not firm or appear puffy, the rubber tip attached to a brush should be inserted between the teeth to a massage the gum tissue called the interdental papilla.

Stimudents or toothpicks are also effective. Oral irrigation removes debris but is ineffective against plaque deposits. Irrigation is a supplement, not a substitute, for brushing and flossing. If inflammation and bleeding do not clear up after one or two weeks of conscientious oral hygiene, a dental construction is in order. Once plaque and tartar are firmly established on the teeth and beneath the gum, professional prophylaxis, including subgingival scaling is necessary to remove these deposits.

Around the third month of pregnancy and during menstruation, some women experience minor gum inflammation, including swelling and enlargement of the interdental papilla. Occasionally, a large overgrowth of the gums takes place at the border of a few teeth. This so-called pregnancy tumour is not a neoplasm but rather a response of the gum to local irritation.

Hormonal changes associated with pregnancy and menstruation particularly in the presence of poor oral hygiene, are the cause of this gingivitis.
The condition is painless and notable mainly for an increase in the size of gum papilla and minor bleeding on brushing. The gums also appear bluish or bright red.

Careful brushing and flossing reduce inflammation and swelling. Hard calculus must be removed by a dental prophylaxis. If a growth on the gum becomes annoyingly large, it can be removed surgically. However, most symptoms disappear after pregnancy and the cessation of menstruation.

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