"Gingivitis" Simply Explained

What is Gingivitis?

“Gingivitis” originates from the combination of two words…gingivae “gums” and itis “inflammation”. Gingivitis, simply put, means “inflammation of the gums”. The gum is the part of the mouth directly encircling the tooth which we can see and touch when we open our mouths. Gingivitis can be mild, moderate, or severe.

In a healthy oral state, the gingivae immediately encircling the tooth which we refer to as the “free and attached gingivae”, usually appears light pink in color and with a stippled surface (like the appearance of an orange peel). The color of the gingivae may vary depending on our skin color; in some dark-skinned individuals, the gingivae may appear brownish in color - this is normal.

When the gums are not healthy, the stippling of the attached gingivae is lost and the surface appears shiny with a dark pink to reddish discoloration. Also, the beautiful art of “mountain peak” appearance of the gingivae found in between the teeth appears “rolled” when the gums are inflamed or unhealthy. Oftentimes, when these happen, the gums start to bleed when light pressure is applied due to the tiny blood vessels within the gums being more superficial and easily disrupted. This then becomes a common complaint in the dental office when the patient says “My gums bleed sometimes when I brush my teeth”.

Gingivitis can be seen in any age group as long as there are teeth present in the mouth. Also, some people without teeth who wear intraoral appliances like full dentures can also experience gingivitis. Orthodontic brackets and wires and also some intraoral jewelry can cause gingivitis depending on the location.

Causes of Gingivitis:

There are various causes of gingivitis. However, the most common cause is plaque build-up. Plaque is simply a film or collection of left-over food particles mixed up with oral bacteria found on the tooth surface. When tiny food particles are left in the mouth after eating without brushing, within four hours, these microorganisms in the mouth start to reproduce by feeding on the tiny food particles, thereby multiplying and then start to form a complex microbiome. 

The longer the teeth are not cleaned or brushed, the more complex this microbiome becomes and continues to grow in size. Subsequently, within days of not brushing, calcium and some other mineral from food and from those naturally produced by the body found in saliva, invade the growing microbiome and cause it to harden and become even more difficult to brush off. At this time, the plaque has become “calcified” and now referred to as “calculus” further irritating the gums and causing even more bleeding of the gums.

Calculus is more dangerous than plaque because it attaches to the tooth and cannot be removed by simply brushing the teeth. Once calculus has formed on the tooth surface, the affected teeth will need to be cleaned using special instruments in the dental clinic. Calculus can invade the supporting structure of the teeth and cause it to become loose and subsequent tooth loss. 

How to Prevent Gingivitis at Home or at Work:

-Regular tooth brushing

-Flossing

Generally, tooth brushing is recommended twice daily to remove plaque from the teeth. Regular tooth brushing removes plaque and prevents it from becoming harmful to the teeth. Flossing at least once daily is also recommended in addition to brushing. Flossing helps to remove plaque found in between the hidden contact area of the teeth. The combination of both tooth brushing and flossing makes for efficient teeth cleaning. This helps to keep the teeth and gums in a healthy state.

Some people brush more than twice daily but still have plaque and calculus build up on their teeth. This could be due to a combination of factors, like, 

-Snacking frequently on sweet foods (including milk -yes, milk does contain sugar); 

-Teeth arrangement like crowded teeth, creating nukes for food accumulation; 

-Not brushing efficiently; 

-Certain health conditions like Sjogren’s syndrome; 

-Taking certain food supplements like calcium (do not stop taking food supplements if recommended by your doctor), etc.

Patients with fixed orthodontic brackets and wires are at a high-risk of gingivitis because of the shape of the brackets which favors food accumulation and also due to the difficulty with cleaning in between the brackets. Some brackets are attached close to the surface of the gums thereby worsening the condition. There are special brushes used for cleaning orthodontic brackets and wires. Also, some interdental brushes can be used to clean between the brackets, wires, and the teeth. 

In patients who wear removable intraoral appliances, it is recommended to remove and clean them after every meal. Removable intraoral appliances like full and partial dentures should be cleaned using room temperature water, soft soap, and a denture brush. 

It is also recommended that patients wearing fixed or removable full or partial dentures have regular dental visits at least twice a year (recommended 3 times a year) to clean and help monitor the health of their gums.

Sadly, some patients with fixed partial dentures or bridges do not clean or floss beneath their bridge either due to ignorance or inability to floss beneath the bridge - some healthy teeth have been lost due to non-compliance of cleaning the bridge through the accumulation of plaque and calculus (and sometimes extensive tooth decay) in the area.

Gingivitis caused by intraoral jewelry found in contact with the gums is oftentimes due to accumulation of plaque and/or calculus on the jewelry if it is not properly cleaned daily. This could be tongue or lip jewelry; and sometimes tooth jewelry. Grills can also be included in this category.

What to Expect During Dental Exam/Prophylaxis:

Regular visits to the dentist can help prevent chronic gingivitis caused by plaque and calculus accumulation on natural teeth or intraoral appliance by getting regular dental exams and/or dental prophylaxis and also finding early stages of the causes of potential tooth loss. 

Usually, your dentist will do an intraoral exam of your teeth and gums and determine what treatment is best for your gums and teeth. Patients generally receive light tooth scaling and polishing for mild gingivitis, or general tooth scaling and polishing for mild to “moderate” gingivitis. In some cases of moderate or severe gingivitis, your dentist will either use more advanced cleaning procedures like the use of laser treatment or may refer you to a gum specialist known as a “Periodontist” to assess and best manage your gingival health condition. 

The dentist will also determine if the patient will need a “deep cleaning” (scaling and root planing) if the attachment apparatus of the teeth have been affected. Depending on the severity of the condition, the patient may also need to see a specialist - Periodontist. Fluoride is a natural mineral that is also used in combination with dental prophylaxis to help strengthen the teeth. It is a common ingredient found in most toothpaste in very small amounts for daily use.