GUM DISEASE (GINGIVITIS AND PERIODONTITIS)

What are Periodontal Diseases?
Periodontal disease, also known as gum disease, can be classified into gingivitis and periodontitis. Gingivitis refers to the swelling of gums, whereas periodontitis affects the gums as well as the bone supporting the tooth.

Periodontitis can result in eventual bone loss and loss of teeth due to mobility. Gingivitis (gum inflammation) precedes periodontitis, but not all gingivitis cases can progress to periodontitis.

What are the Types of Periodontal Diseases?
So, the two types of periodontal diseases include:

• Gingivitis: Swelling of the gums and the soft tissues surrounding the teeth.
• Periodontitis: Advanced form of the disease which originates from the gums and spreads to the underlying tissues such as the bone supporting the tooth.

The different types of periodontal diseases have to be treated in a specific manner, and the treatment protocol varies according to the type.

What are the Causes of Periodontal Diseases?
The primary cause of the periodontal disease is the plaque and tartar build-up on the tooth surface . The plaque and tartar consist of colonies of microorganisms that are responsible for the initiation and progression of periodontal disease.

The plaque deposits form on the teeth a couple of hours after brushing the teeth, and inadequate cleansing measures will result in the multiplication of the microorganisms in the oral environment.

Our body also behaves like a double-edged sword wherein while defending against the microbial infection, the cells of our immune system release substances that cause inflammation and simultaneous destruction of the periodontal tissues.

Initially, it causes the first stage of the disease, which is ‘gingivitis’ (swelling of the gums) and with the continuous build-up of plaque, there is a destruction of the underlying periodontal ligament and alveolar bone.

This results in the more severe form of the disease that is known as ‘periodontitis.’

There is a snowball effect where the plaque build-up below the gum line causes the gums to detach and form a space between the tooth and it is called a ‘periodontal pocket.’

The pocket allows for more plaque accumulation, and the cleansing becomes even more difficult, resulting in the underlying destruction of the periodontal tissues.

If left untreated, it can cause eventual tooth loss as the supporting periodontal structures like the periodontal ligament, cementum, and alveolar bone get destroyed due to the spread of the inflammatory process .

Another clinical manifestation is the formation of calculus (tartar) due to the prolonged accumulation of plaque on the tooth surface.

Calculus is the hardened, calcified form of the plaque, and it cannot be easily removed with the toothbrush. Calculus is rougher than enamel, and it favors further plaque accumulation culminating in a downward spiral of periodontal disease.

What are the Risk Factors for Periodontal Diseases

1. Smoking/Tobacco Chewing: Smoking is one of the major risk factors for periodontal disease . The ‘pack-years,’ which is the number of cigarettes smoked and the duration of the smoking habit, determine the extent of the severity of the periodontal disease. The smokers do not respond favorably to periodontal therapy, and smoking cessation has been shown to improve periodontal tissue status.
2. Diabetes: Periodontal disease is one of the major complications in diabetes . It has been shown that periodontal disease is worsened in diabetic individuals due to the high glucose content. Also, periodontal therapy is not recommended in individuals with uncontrolled diabetes.
3. Genetic: Sometimes, it is all about the genes. Genetic predisposition has been one of the probable risk factors for periodontal disease . Some people are more prone to periodontal disease, but with proper preventive and treatment programs, periodontal disease can be controlled.
4. Stress: Stress has a direct effect on the body’s immune system, and it can weaken it. This makes periodontal disease worsen and difficult to treat .
5. Mal-aligned Teeth: Teeth that are crowded or malposed can be plaque retentive zones. Proper oral hygiene measures need to be followed, and if not adhered to, it can result in worsening of periodontal disease .
6. Hormonal Fluctuations: Various stages in a woman’s life cause the hormones to fluctuate and this results in a detrimental effect on the periodontal tissues. During pregnancy or puberty, women should be more cautious as the hormonal levels can temporarily aggravate the periodontal disease process .
7. Medications: Certain medications like anti-epileptics (Phenytoin), anti-hypertensive (Nifedipine) and immunosuppressants (Cyclosporine) causes enlargement of the gums . This can be corrected when the drug is substituted, and the enlarged gums are guided back to periodontal health.

What are the Signs and Symptoms of Periodontal Diseases?
The mouth is the mirror of the entire body and it is pivotal not to know the difference between normal and diseased areas.

The gums normally appear pink in color with a well-defined contour and are firm in their consistency. The inflammatory disease process because of the microorganisms results in a change in the color, contour, and consistency. Since the periodontal disease can be painless, it is crucial to note these signs in the oral cavity.

Gingivitis

1. Swollen gums
2. Bleeding from gums
3. Red/Bluish red gums
4. An ill-defined contour of the gums

Periodontitis

1. Swollen and tender gums
2. Bleeding from gums
3. Red/Bluish red gums
4. Persistent bad breath or a bad taste in the mouth
5. Gums that recede or move towards the root
6. Mobile teeth
7. Visible pus in the surrounding teeth and gums

What are the Different Stages of Periodontal Disease?
In the gingivitis stage of the disease, it is usually reversible, and with the removal of plaque and tartar, it can revert to normalcy.

In mild-moderate periodontitis, periodontal therapy can be advised in various phases along with a strict oral hygiene maintenance regiment. In advanced forms of periodontal disease, the extraction of hopeless teeth may be the only treatment modality that can be advisable in those cases.

What are the Different Treatments Available for Periodontal Disease?

1. Scaling: This treatment is done to remove the tartar accumulation on your teeth and gums. These hard and soft deposits harbor bacteria and can contribute to decay and/or periodontal disease. The frequency varies from person to person, and it is individualized, but the general recommendation time is every 6 months.
2. Curettage: It is a form of deep cleaning where the inflamed and diseased gum tissue is removed, and this facilitates the healing of the tissues supporting the teeth.
3. Flap Surgery: Gingival flap surgery is a type of surgical procedure. The gums are separated from the teeth, and this allows the periodontist to reach the roots of the teeth and bone. The diseased tissues, along with the hard deposits, are removed from the bone and root surfaces of the teeth. The gums are folded back and sutured.
4. Periodontal Plastic Surgery: Gingival recession or receding gums is the exposure of the roots of the teeth caused by a loss of gum tissue and/or retraction of the gingival margin from the crowns of the teeth due to a high frenum. A gingival graft, also called gum graft or periodontal plastic surgery, is a generic term for any periodontal procedure in which the gum tissue is grafted to cover the exposed roots or to augment the keratinized tissue.
5. Splinting: The teeth can become loose and mobile due to periodontal disease as a result of the loss of supporting bone or heavy bite stress. Periodontal stabilization splints are used to stabilize the teeth that have become loose and make it more conducive to taking up biting forces.

What Can Be Done to Prevent Periodontal Disease?
Just like most of the diseases, periodontal disease is also preventable, provided these habits are inculcated in your daily routine.

1. Brushing the Right Way: Take a pea-sized amount of toothpaste and brush your teeth using the recommended brushing technique prescribed by your dentist. The brush techniques can be customized according to the individual and his/her periodontal status.
2. Brushing Twice a Day: It is mandatory to brush both in the morning and after your dinner in the night. The bacteria can hide on the tongue too. Do not forget to remove it.
3. Floss on: The areas in between your teeth cannot be accessed with the toothbrush, and the plaque build-up there has to be removed with dental floss.
4. Swish with a Mouthwash: A mouthwash can help in removing the plaque and tartar that has been left behind after brushing and flossing. Certain medicated mouthwashes can also help in preventing plaque and tartar build-up on the tooth surfaces.
5. Be Aware of Your Risk: When you have certain systemic diseases or consuming certain medications as mentioned above, please be aware of your risk for periodontal disease. If you are a high-risk individual, make sure to consult with your dentist.
6. Refer to a Periodontist: If you have been diagnosed with periodontal disease, your dentist will refer you to a periodontist who is a specialist in treating your gums and alveolar bone. Make sure to follow the instructions to achieve your periodontal health.

What are the Home Remedies for Periodontal Disease?

Salt
The antiseptic and antibacterial properties of salt can take care of the bacteria that cause periodontitis. Plus, it can reduce inflammation and pain .

• Add 2 teaspoons of salt to a glass of lukewarm water. Swish a mouthful of this solution around in your mouth for 1 minute. Spit and do it again. Follow this treatment 2 or 3 times a day.
• Another option is to mix a pinch of salt and a little mustard oil to make a paste. After brushing your teeth, rub this mixture on the gums and leave it on for 5 minutes. Then, rinse thoroughly with warm water. Follow this remedy daily in the morning.

Oil Pulling
In traditional medicine, oil pulling has been used extensively to strengthen the teeth, gums, prevent oral malodor, bleeding gums, dryness of the throat, and cracking of lips. It can even strengthen and promote good periodontal health .

1. Swish a mouthful of organic, unrefined coconut oil or sesame oil around in your mouth for 15 to 20 minutes.
2. Spit it out and rinse your mouth with warm water.
3. Do this daily in the morning before brushing your teeth.

Turmeric
Turmeric can easily kill the bacteria present in the gums as well as relieve pain and inflammation. Curcumin is the active ingredient in turmeric, and it has potent anti-inflammatory and antioxidant properties. It also promotes oral health .

• Use turmeric powder to brush your teeth and gums using a soft-bristle toothbrush. Do this 2 times a day for a few weeks.
• Alternatively, prepare a gum pack with turmeric to treat periodontitis. Mix a pinch of turmeric powder with a little water or vitamin E oil to make a paste. Apply it on your gums before going to bed. The next morning, rinse your mouth with warm water. Do this once daily for several weeks.

Guava
Being rich in vitamin C, guava is also considered an excellent remedy for periodontitis. It works as an anti-plaque agent and helps in removing plaque present on the teeth and gums. Plus, it’s anti-inflammatory, and analgesic properties help reduce swelling and pain on the gums .

• Wash some tender guava leaves. Chew the leaves thoroughly, then spit them out. Do this on a regular basis to stop bleeding and reduce the risk of pus forming in the gums.
• Another option is to cut unripe guava into four pieces. Sprinkle salt on the guava pieces and chew them slowly. It will help reduce plaque and make your gums and teeth strong.

Neem
Indian lilac, also known as neem, is also very beneficial in getting rid of periodontitis. Its antibacterial properties help keep your gums free from harmful bacteria. Also, it helps combat bad breath and keeps your gums and teeth healthy .

• Extract the juice from a few neem leaves. Apply this juice on the gums and teeth, allow it to sit for 5 minutes and then rinse it off with warm water. Follow this treatment 1 or 2 times daily.
• You can also use soft neem twigs to brush your teeth and gums twice daily.

Holy Basil
It is a good remedy for treating bleeding gums, one of the most common symptoms of periodontitis. Its antibacterial property can reduce the effect of harmful bacteria in the mouth. It also helps safeguard against other dental problems like toothaches and pus or pain in the gums .

• Mix 1 teaspoon of dried and powdered holy basil leaves with enough mustard oil to make a paste. Rub this paste on your teeth and gums and brush gently using a soft-bristle toothbrush. Do this 2 times a day for several weeks.
• You can also drink a few cups of basil tea daily or use it to rinse your mouth to treat and prevent periodontitis.

Cayenne Pepper
It has anti-inflammatory properties that can help reduce swelling of the gums caused by periodontitis. Being rich in capsaicin, cayenne pepper also helps in reducing pain .

1. Put a few drops of cayenne pepper tincture on a soft-bristle toothbrush.
2. Use it to brush your gums for a few minutes.
3. Rinse your mouth thoroughly with water.
4. Follow this treatment once daily to help relieve pain and reverse periodontitis.

Tea Tree Oil
Tea tree oil has natural antibacterial and antiseptic properties that help fight microorganisms. Also, it helps reduce bleeding and gingival inflammation . Tea tree oil is also beneficial for other dental issues like oral thrush and herpes.

1. Apply tea tree oil in the form of the gel using a toothbrush twice daily for several weeks.
2. Another option is to add a drop of tea tree in your regular toothpaste and brush your teeth with it twice daily.