What is gingivitis?

Gingivitis, also called gum disease or periodontal disease, describes the events that begin with bacterial growth in your mouth and may end -- if not properly treated -- with tooth loss from destruction of the tissue that surrounds and supports your teeth. (Gingivitis and periodontitis are two distinct stages of gum disease.)

What's the difference between gingivitis and periodontitis?

Gingivitis usually comes before periodontitis. However, it is important to know that not all gingivitis progresses to periodontitis.

In the early stage of gingivitis, bacteria in plaque build up and cause the gums to become inflamed (red and swollen) and often bleed during tooth brushing. 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.

When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums collect more bacteria and debris and can become infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line.

Toxins, or poisons, produced by the bacteria in plaque as well as the body's "good" enzymes (involved in fighting infections), turn against the body and actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, in fact, is the leading cause of tooth loss in adults.

What causes gingivitis/periodontal disease?

Plaque is the primary cause of periodontal disease. However, other factors can contribute and advance the gum disease. These include:

  • Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive. Thus makes it easier for gingivitis to develop.
  • Illnesses, which may affect the condition of your gums. This includes diseases, such as cancer or HIV, that interfere with the immune system. Because diabetes affects the body's ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.
  • Medications can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication diphenylhydantoin (marketed as Dilantin®) and the anti-angina drug nifedipine (marketed as Procardia® or Adalat®), can cause abnormal growth of gum tissue.
  • Bad habits, such as smoking, make it harder for gum tissue to repair itself by upsetting the balance of repair and breakdown of oral tissues.
  • Poor oral hygiene habits, such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop resulting in a buildup of soft bacteria and calculus (tartar).
  • Family history of dental disease can be a contributing factor in the development of gingivitis. This is usually a result of the type of bacteria (normal flora) acquired during early life making it more important to control it with brushing and flossing.

What are the symptoms of periodontal disease?

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

  • Gums that bleed during and after tooth brushing
  • Red, swollen, or tender gums
  • Persistent bad breath or bad taste in the mouth
  • Receding gums
  • Formation of deep pockets between teeth and gums
  • Loose or shifting teeth
  • Changes in the way teeth fit together upon biting down, or in the fit of partial dentures

Even if you don't notice any symptoms, you may still have some degree of gum disease. In some people, gum disease may affect only certain teeth, such as the molars. Only a dentist or a periodontist can recognize and determine the progression of gum disease.

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