Bleeding gums whenever brushing and bad breath could be signs of gingivitis, dentists say. According to Dr Roger Anamali, a dental surgeon at Baho International Hospital, Nyarutarama, gingivitis means inflammation of the gums, or gingiva. It commonly occurs because a film of plaque, or bacteria, accumulates on the teeth. Gingivitis is a non-destructive type of periodontal disease, but untreated gingivitis can progress to periodontitis. This is more serious and can eventually lead to loss of teeth, he says. “Gingivitis is a common type of periodontal disease and some of its signs include red and puffy gums that bleed easily when the person brushes their teeth. Gingivitis often resolves with good oral hygiene, such as longer and more frequent brushing, and flossing. In addition, an antiseptic mouthwash may help,” he says. He adds, in mild cases of gingivitis, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately. Dr AbduKadir Mamataliev, a dentist at Deva Medical Center, Nyarutarama, says in the early stage of gingivitis, bacteria in plaque build up, causing the gums to become inflamed and to easily 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. He adds, toxins or poisons produced by the bacteria in plaque, as well as the body’s good enzymes involved in fighting infections, 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 loose, and tooth loss occurs. Gum disease is the leading cause of tooth loss in adults. TYPES Dr Anamali explains that there are two main categories of gingival diseases, which include, dental plaque-induced gingival disease: This can be caused by plaque, systemic factors, medications, or malnutrition, while the second type is non-plaque induced gingival lesions. This can be caused by a specific bacterium, virus, or fungus. It might also be caused by genetic factors, systemic conditions (including allergic reactions and certain illnesses), wounds, or reactions to foreign bodies, such as dentures. Sometimes, there is no specific cause. CAUSES AND RISK FACTORS Dr Anamali says the most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth. The plaque triggers an immune response, which, in turn, can eventually lead to the destruction of gingival, or gum tissue. It may also, eventually, lead to further complications, including the loss of teeth. Anamali explains that dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonising bacteria that are trying to stick to the smooth surface of a tooth. He adds, this bacteria might help protect the mouth from the colonisation of harmful microorganisms, but dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis, a gum infection. When plaque is not removed adequately, it can harden into calculus, or tartar, at the base of the teeth, near the gums. This has a yellow colour. Calculus can only be removed professionally. Plaque and tartar eventually irritate the gums, causing gum inflammation around the base of the teeth. This means that the gums might easily bleed, Dr Anamali adds. Dr Mamataliev adds that poor oral hygiene habits, such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop. Dr Mamataliev points out that changes in hormones is one of them, this may occur during puberty, menopause, the menstrual cycle, and pregnancy. The gingiva might become more sensitive, raising the risk of inflammation. Some diseases like cancer, diabetes, and HIV are linked to a higher risk of gingivitis. “Oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin, an anticonvulsant, and some anti-angina medications can cause abnormal growth of gum tissue, however, regular smokers more commonly develop gingivitis, compared to non-smokers,” Dr Mamataliev says. He notes that the risk of gingivitis increases with age and poor diet, for example gum disease is linked to a vitamin C deficiency. Family history, those whose parent or parents have had gingivitis have a higher risk of developing it too. This is thought to be due to the type of bacteria we acquire during our early life. SIGNS AND SYMPTOMS Dr Anamali says in mild cases of gingivitis, there may be no discomfort or noticeable symptoms. Signs and symptoms of gingivitis might include; bright red or purple gums, tender gums that may be painful to touch, bleeding from the gums when brushing or flossing, halitosis or bad breath, inflammation or swollen gums, receding gums and soft gums. DIAGNOSIS AND TREATMENT Dr Anamali says a dentist or oral hygienist will check for symptoms, such as plaque and tartar in the oral cavity, and checking for signs of periodontitis may also be recommended. This may be done by X-ray or periodontal probing, using an instrument that measures pocket depths around a tooth. If diagnosis happens early, and if treatment is prompt and proper, gingivitis can be successfully reversed. Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home, Dr Anamali says. He adds that scaling can be uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive. The dental professional will explain the importance of oral hygiene and how to brush and floss effectively. Dr Anamali urges follow-up appointments, with more frequent cleanings if necessary. Fixing any damaged teeth also contributes to oral hygiene. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar. They may also irritate the gums. He advises everyone to brush their teeth at least twice a day. Use an electric toothbrush, floss teeth at least once a day, regularly rinse mouth with an antiseptic mouthwash and keep in mind to visit a dentist to recommend a suitable brush and mouthwash. COMPLICATIONS Dr Anamali continues to say, treating gingivitis and following the dental health professional’s instructions can normally prevent complications. However, without treatment, gum disease can spread and affect tissue, teeth, and bones. “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 and form pockets. These small spaces between teeth and gums collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line,” Dr Mamataliev says.
