Gingival and Periodontal disease

Gingivitis is an inflammation or swelling of the gums, while Periodontitis means the actual infection in gums. Gingivitis is a sign to show the chance of developing gum disease. When gingivitis is left untreated, it can progress to periodontitis.

Gum disease or periodontal disease begins with bacterial growth in your mouth. There will be tooth loss due to destruction of the tissue that surrounds your teeth.Gingivitis precedes to periodontitis. However, it is important to know that not all gingivitis progresses to periodontitis

GINGIVITIS

Gingivitis is inflammation (swelling) of gums caused by bacterial plaque build-up in between gums and teeth. There is bleeding observed during brushing, as the gums are swollen and brushing causes irritation to the inflamed gumline. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.

Gingivitis is seen in most people and is usually reversible if treated

Symptoms of gum disease:

• Bleeding on brushing 
• Red or swollen gums
• Mild Sensitivity of teeth to cold or sweets.
• Bad breath or halitosis .
• Yellow or brown hardened deposits seen on tooth surface.

Treatment

Treatment usually involves getting a routine oral prophylaxis(professional teeth cleaning) done at your dental office.

Maintenance of proper oral hygiene, proper brushing helps in prevention

Routine annual dental check up along with regular annual cleaning helps to keep this disease incheck.

PERIODONTITIS

Periodontitis occurs when there is progress of bacterial activity further into the gumline. Untreated gingivitis progresses to periodontitis. Where gingivitis involves only the gums,periodontitis involves gums and underlying structures including bone and periodontal ligament(the band that attaches the tooth to the gums). Small gaps open up in between the teeth and gums and pocket formation is seen. This further progresses to cause a receding gum line, underlying bone loss, tooth mobility,etc

Symptoms of periodontal disease:

•  Bleeding on brushing
• Red or swollen gums.
• Receding gum line
• Loose or mobile teeth.
• Drifting/migration of teeth
• Increased sensitivity of teeth to cold or sweets because of increased root exposure.
• Bad breath or halitosis .
• Yellow or brown hardened deposits seen on tooth surface extending onto the root surface below.

Causesof  Gingival or Periodontal disease

• Poor oral hygiene
• Improper brushing technique, irregular brushing.
• Hormonal changes(during teenage years ,pregnancy)
• Illnesses (HIV, cancer, diabetics)
• Medications(like anti-epilepticdrugs,etc)
• Habits such as smoking,paan chewing
• Family history

The dentist will examine your gums and note the sign of inflammation.The dentist will use an instrument called the periodontal probe to check for and measure any pockets around the teeth. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimetres. This test for pocket depth is usually painless. The dentist will ask about your medical history to identify the risk factors such as smoking or diabetes that may contribute to gum disease.

Treatment

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the depth of the gum disease.

Deep root planning and oral prophylaxis are the primary mode of treatment.

Sometimes gingival flap surgeries will be advised to clean the gums and the tooth

Laser treatment for bacterial population irradication in pockets

Any type of treatment requires that the patient maintains good daily care at home. The dentist also suggests to avoid smoking, as a way to improve your treatment results.

Prevention

You can keep your gums and teeth healthy by:

• Brushing your teeth twice a day with a fluoride toothpaste.
• Flossing regularly or use of interdental brush to remove plaque build-up seen in  between teeth
• Visit your dentist routinely for a check-up and professional cleaning.
• Quit smoking/paan chewing.

Conclusion

So, to conclude the sooner gingival disease is treated the better the prognosis. If left   untreated can progress to bone loss and eventual loss of tooth. Get annual regular dental check-ups and have consistent good oral hygiene practices.

Author

Dr.Justin Jacob

Diabetics and Periodontal / Gum Health

• Periodontitis is a common chronic inflammatory disease characterized by the destruction of the supporting structures of the teeth. It is highly prevalent.

• Epidemiological data confirm that diabetes is a major risk factor for periodontitis. There is a clear relationship between the degree of hyperglycemia (high blood sugar levels) and the severity of periodontitis. There is emerging evidence to support the existence of a two-way relationship between diabetes and periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycemic control.

• Incidences of macro albuminuria and end-stage renal diseases are increased twofold and threefold, respectively, in diabetic individuals who also have severe periodontitis compared to diabetic individuals without severe periodontitis.

What is periodontitis?

Periodontitis is a broad term and for the purpose of simple definition it is inflammation of the gum and supporting structures (including underlying bone).It takes into account the clinical presentation, age at diagnosis, rate of disease progression, and systemic and local factors that may increase risk.

Periodontitis is a slowly progressing disease but the tissue destruction that occurs is largely irreversible and is divided broadly as:

1.Gingivitis: where the inflammation is confined to the gingiva(gums), and is reversible with good oral hygiene

2. Periodontitis: where the inflammation extends and results in tissue destruction and alveolar bone resorption(that is underlying bone).

3. Periodontal Pockets:Tissue destruction in periodontitis results in the breakdown of the collagen fibers of the periodontal ligament(fibrous  attachment of tooth to bone) resulting in the formation of a periodontal pocket between the gingiva and the tooth.

4. ‘Pockets’ are not evident on simple visual inspection, and assessment using a periodontal probe in dentist’s office is essential. In the early stages, the condition is typically asymptomatic; it is not usually painful, and many patients are unaware until the condition has progressed enough to result in tooth mobility. The pockets deepen as a result of the further destruction of fibers of the periodontal ligament and the resorption of the alveolar bone that occurs parallel with the progressing attachment loss.

5. Advanced periodontitis is characterized by gingival(gum) erythema(redness) and edema(swelling), gingival bleeding, gingival recession, tooth mobility, drifting of teeth, suppuration from periodontal pockets, and tooth loss.

Associations between diabetes and periodontitis

•  Diabetes has been unequivocally confirmed as a major risk factor for periodontitis. The level of glycemic control is of key importance in determining increased risk. The majority of research has focused on type 2 diabetes mellitus as a risk factor for periodontitis, probably because both diseases have historically tended to develop in patients in their 40s and 50s. However, type 1 diabetes mellitus also increases the risk of periodontitis, and all patients with diabetes (including children and young adults) should be considered to be at increased risk of periodontitis..

•  Dentists have long been aware of the importance of a diagnosis of diabetes in their patients, and various oral conditions are associated with diabetes, including xerostomia and candidal infections as well as periodontitis.

·    

       • People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

·     • Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

·      • Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Clinical signs of periodontitis:

•  Increased redness of the gum tissues along the teeth is a classic sign of gingivitis, a condition that indicates that there is an active inflammatory response to bacterial infection.

• The use of a toothbrush or a toothpick to gently touch the gums of diabetic patients with inflammation will provoke bleeding that will cease within minutes. Dentists always suggest a thorough dental examination if such bleeding is common throughout a patient's mouth.

• The presence of white or gray deposits on teeth suggests that dental treatment may be necessary.

•  Spacing between upper front teeth and mobile teeth are other signs of periodontitis.

Conclusion

Patients with diabetes are usually poorly informed about the relationship between periodontitis and diabetes. Therefore, health care providers of patients with diabetes should be aware of this link and inform their patients about the need for good oral health.

Referral of patients with uncontrolled diabetes for a dental evaluation and periodontal treatment may result in better control of blood glucose levels.

Diabetic patients should therefore get routine dental check updone at least every six months.

Author: Dr Justin Jacob