Gum Disease

The gum tissue that surrounds the teeth is called gingiva. The gingiva, the bones forming the tooth socket, and the supporting ligaments are referred to collectively as periodontium. Gum or periodontal disease refers to a variety of problems affecting the gums and bone that hold the teeth in place. These problems include bleeding, swelling, receding gums, and loose teeth. Nearly 85 percent of the population has some form of this disease. Since there is no pain or discomfort present during the initial stages, people often ignore the signs and symptoms, believing them to be normal occurrences. For example, some bleeding during brushing and flossing, or loosening of teeth as one gets older is taken for granted. Knowledge about gum disease is, therefore, imperative to dental health.

Healthy gums are firm and springy, and vary in color depending on the thickness of the outer layer. A change in normal color is one of the first signs of gum disease, which has three stages: gingivitis, periodontitis, and advanced periodontitis (pyorrhea). This progression is illustrated by the figures above.

Gingivitis-an inflammation of the gums-is the initial stage of gum disease and the easiest to treat. The direct cause of gingivitis is plaque the soft, sticky, almost colorless film that forms continuously on the teeth and gums. Plaque is not harmful if it is removed before it begins to accumulate. However, if teeth and gums are not cleaned thoroughly every twenty-four to thirty-six hours, the bacteria in plaque produce toxins and enzymes that inflame the gums. Due to this inflammation, the gums become slightly red and puffy and may bleed during brushing or flossing; the gums may also begin to recede (pull away) slightly from the tooth or teeth. During this early stage of gum disease, called gingivitis, damage can be reversed since the bone and connective tissue that hold the teeth in place are not yet affected.

Other factors that may contribute to gingivitis include habitual clenching and grinding of the teeth and mouth-breathing. A diet that is high in simple carbohydrates and sugar and deficient in vitamins also contributes to gingivitis, as well as the use of tobacco, drugs, and alcohol. Heredity, hormonal imbalances (during pregnancy and puberty), oral contraceptives,
and stress are other possible contributors.

If gingivitis is left untreated, the inflammation can spread to the roots of the teeth developing into periodontitis. During this second stage of gum disease, the plaque penetrates deeper into the gum tissues and eventually begins to affect the underlying bone. As the disease continues to advance, the gums further recede from the teeth giving them an elongated appearance. Gum pockets form, in which more plaque and food debris collects. These pockets prevent easy cleaning and elimination of plaque under the gums, causing halitosis (see Bad Breath in Part Two) and pain. Accumulation of bacteria causes infections that begin to destroy the bone. Abscesses may form, the teeth may shift or become loose, and the bite may change. Tartar or mineralized plaque deposits further irritate the gums. Any pressure on the gums during this stage may cause heavy bleeding or the discharge of pus.

The third stage of gum disease, advanced periodontitis or pyorrhea, is marked by major gum recession and severe bone loss. At this point, the teeth are often too loose to be saved and frequently have to be pulled.

Acute necrotizing ulcerative gingivitis (ANUG), also called Vincent’s disease or trench mouth, is another type of gum disease. Symptoms of ANUG include ulcers along the gum line and between the teeth. It is often accompanied by fever, swollen glands, nausea, headaches, and general weakness. Although ANUG appears suddenly, its causative factors-poor oral hygiene, physical and mental stress, weakened immune system due to illness-usually have been present for some time.

Conventional Treatment


The only effective long-term treatment of gum disease is to deal with its underlying causes and to keep the teeth and gums clean. Good oral hygiene includes regular professional cleanings. Such cleanings are extremely important at the first sign of gingivitis.

Be aware that each stage of gum disease requires a different type of cleaning. For early-stage gingivitis, a one-time professional cleaning is usually sufficient. During this visit (as well as visits for more advanced gum disease), a periodontal probe (see margin figure) will be used to determine the degree of gum damage. One end of the probe has bands that indicate millimeters. This end is gently placed between the tooth and gum to measure gum pocket depth (see margin figure). For healthy gums, pocket depth is from 2 and 3 millimeters. As mild to moderate pain may be felt during the cleaning, your dentist may first numb the area with a topical anesthetic. After the cleaning, you will probably be asked to return in three months for a check-up and another routine cleaning. If the gums appear healthy at that point, you will likely be asked to either continue the three-month recalls or return in four to six months.

Periodontitis and advanced periodontitis require more than a routine cleaning. Bacteria has caused a build-up of plaque and tartar deep into the gum tissue and on the tooth root. Scalers (see margin figure) are used to scrape plaque and tartar off the surface of the teeth (scaling), including the roots (root planing). Plaque and infected tissue are removed from the walls of the gum pockets (curettage). Depending on the extent of the infection, the amount of plaque and tartar, and the depth of the pockets, the procedure may require one or more visits. Local anesthetic may be used during this procedure if the pain is severe. Antibiotics may be prescribed if abscesses are present.

Your dentist may refer you to a periodontist for deep-cleanings or for surgery to remove diseased gum tissue and to reshape the bone. However, surgery will not bring about a permanent cure unless the cause of the disease is determined and eliminated. In the case of advanced periodontitis, splinting the teeth (holding several teeth in place by means of a wire, plastic, or resin material) and bone and gum grafting may be considered instead of tooth extraction.

Nutritional Supplements

Homeopathic Treatment


Dissolve the tablets under your tongue. Do not eat or drink for fifteen minutes prior to or after taking medication.

Herbal Treatment

Recommendations

• Avoid mouthwashes that contain alcohol; they may irritate and dry gum tissues.

• If a gum infection exists, use a 3 percent hydrogen peroxide solution (available at any pharmacy) as a rinse; it will help destroy bacteria and clean the gum tissues. However, long-term use of hydrogen peroxide is not recommended as it may eventually destroy delicate gum tissue, leaving a whitish patch behind.

• Toothpaste with aloe vera and baking soda (Grace, for example ) is more soothing to the gum tissues than pastes with harsh chemicals.

• Consider using an electric toothbrush system (see margin note), which many dentists feel is very effective in cleaning teeth and stimulating gums.

• Avoid spicy foods, foods that are high in sugar, and meats. Because healing is promoted by proper nutrition, eat a balanced diet that includes raw and steamed vegetables and fruits. Drink adequate amounts of water-at least eight 8-ounce glasses each day-because bacteria tend to thrive in a dry environment. Because of their high sugar content, avoid soft drinks and sodas.

• Medications such as Dilantin, which is used for control of epilepsy, and Inderol, used for hypertension and heart disease, may cause inflammation and swelling of the gums. If proper hygiene does not control the swelling, your physician may need to reduce the dosage or prescribe a substitute.
  

From The Complete Book of Dental Remedies by Flora Parsa Stay, DDS, ©1996. Published by Avery Publishing, New York. For personal use only; neither the digital nor printed copy may be copied or sold. Reproduced by permission.