Tuesday, 26 July 2011


Published in Panorama

Taking care of the gums

Gingivitis is infection and inflammation of the gum and is one of the most common forms of gum or periodontal disease. The basic cause of gingivitis is plaque, which is always present in the mouth and which incidentally gets deposited in the mouth, as soon as teeth erupt in a infants mouth reveals Dr. (Major) Arun Nair, Dentist, Al Rafa Poly Clinic, Gardens, Jebel Ali

Plaque is actually a thin coat of bacteria and food debris adhering to the surface of the teeth. The bacteria on the teeth, along with minerals in the saliva, form tartar or calculus, which in turn provides an ideal environment for more bacteria to accumulate. The buildup creates pockets of bacteria between the gums and teeth, resulting in gum irritation, swelling and bleeding. The tissues surrounding and supporting the teeth are affected, explains Dr.Nair.

What are the symptoms of gingivitis? Tender, swollen or bleeding gums, especially while brushing are the typical symptoms of gingivitis. Also, there may be a change in gum colour from pink to dusky red. The signs of infection are pain, redness or swelling in the gums and halitosis or bad breath even after good brushing, explains Dr.Nair.

Just about any individual of any age can be affected with gingivitis, except newborns, in whom it is very rare, explains Dr.Nair. "The problem can set in as early as when children get their deciduous/milk teeth and parents do not take sufficient care to supervise their brushing or are indifferent to their oral hygiene."

However, certain other factors can predispose one to gingivitis. A certain heredity factor may be involve since bacteria leading to gingivitis may be more harmful to some people's gums than to others (hereditary gingivofibromatosis). Certain drugs reduce the production of saliva, causing the mouth to become dry. Plaque and tartar buildup get augmented without the cleansing effect of saliva. Certain other drugs like nifedipine, phenytoin etc. can cause gingival swelling. Hence, people who are on these drugs for some period of time, can be prone to gingivitis. Certain individuals may have mal-alignment in the teeth. As a result the brush may not be able to reach in those areas to clean the plaque. These individuals could be affected by gingivitis. Smoking and chewing of tobacco are believed to slow the gums' ability to heal itself and to replace tissue destroyed by bacteria. Similarly, individuals with weakened immune system and diabetics with uncontrolled or poorly controlled sugar levels are more susceptible to gingivitis and other gum diseases. Even hormonal changes during pregnancy are believed to make the gums more susceptible to the damaging effects of plaque, explains Dr.Nair.

Left unchecked, gingivitis can lead to a more serious form of gum disease called periodontitis which can even result in loss of teeth, reveals Dr.Nair. While prevention is always better than cure, if you suspect any gum problem, it is better to get it checked at the earliest possible, to prevent the progression of gingivitis to the more serious periodontitis. "Gingivitis is just the beginning and is limited to the gums. In periodontitis in addition to gums, minute periodontal fibres which attach the tooth to the socket and alveolar (jaw)bones get affected. There will be a recession of the gums and reduction in bone level, tooth becomes loose in its socket and unless treated in good time, the tooth will be lost."

As a screen for gum disease, the dentist will measure the depth of the groove between your gums and your teeth, called gingival sulcus, at various sites in the mouth. This is done by inserting a metal probe beneath your gum until he or she feels a slight resistance. If this depth is between 2-3mm, the gums are considered healthy. If beyond 3mm, most likely there is a pocket formed between the tooth and gum, explains Dr.Nair. Also dental X rays will indicate the health of the gums by revealing bone loss.

If gingivitis has progressed to periodontitis, the treatment may be extensive and in addition to scaling and root planning may even include periodontal surgeries like gingivectomy, flap surgery, grafting etc. The best way to prevent gingivitis is to maintain good dental hygiene. This includes regular brushing and flossing of your teeth and periodic professional cleaning to prevent buildup of plaque and tartar.

Dr.Nair enumerates measures to prevent plaque buildup and tartar formation:

Plaque should not be allowed to accumulate and turn into tartar. It is important to select the right toothbrush which can reach and clean your back teeth as well as your front teeth.

Brush twice a day with good brushing technique.

Brush should have a small head with soft bristles. It should be changed once in 3-4 months or earlier if the bristles become frayed. There should be no vigorous brushing that will damage the teeth. Use vertical or circular movements while cleaning outer and inner surfaces of teeth rather than horizontal strokes which can cut into the teeth to cause abrasive lesions and gum recession leading to sensitivity and pain.

Clean the grooves between your gums and your teeth by holding the brush at a proper angle.

Use fluoride toothpaste which helps remove plaque and protects against cavities.

Additional supplements like fluoride containing mouth wash and floss will tend to decrease plaque accumulation. Check the concentration of fluoride and use it accordingly either daily or once a week or fortnightly.

Have periodic checkup with the dentist once every six months at least.

Have your teeth cleaned (scaling and polishing) once a year with the dentist. This is especially important for individuals having mal-aligned teeth, those wearing braces or partial dentures.

Individuals using removable dentures should remove them at night before going to bed.


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