Gum Disease

Causes of gum disease: 

Gum disease often caused by inadequate oral hygiene, leads to plaque builds up on the teeth. Other factors that may contribute to gingivitis include:

• Diabetes
• Smoking
• Hereditary
• Stress
• Malnutrition
• Hormonal fluctuations in puberty, an increase in hormones can increase blood flow to the gums, causing red and swollen gums
• Hormonal changes in pregnancy typically begin in the second or third month through the eighth month of pregnancy.  The symptoms include swollen, sore and bleeding gums
• Hormonal fluctuations during menstruation 
• Hormonal changes in menopause causing sore and bleeding gums
• Substance abuse
• HIV infection
• Injury to the gums
• Prolong use of a particular medication such as Dilantin
• The research found a link between some oral contraceptive pills and gingival inflammation.

Plaque is a combination of sticky material made of bacteria, mucus, and food debris that adheres to the tooth and root surfaces. When calcium in food and saliva combines with plaque, it turns into a hard deposit called calculus or tartar.

Gum disease is a transmitted disease. Exercise precaution when a family member has gum disease.  Do not share toothpaste, drinking glass and all utensils among family members.

There are two types of gum diseases:
1. Gingivitis or gingival disease
2. Periodontitis or periodontal disease

Symptoms

Gingivitis
The symptoms of gingivitis, an early stage and milder form of gum disease  include:

1. Bleeding gums (blood found on toothbrush even with gentle brushing of the teeth or when rinse your mouth)
2. Bright red or red-purple appearance on the gum line
3. Tender gums when touch, but otherwise painless
4. Mouth sores while eating
5. Swollen gum
6. Bad breath
7. Sensitive teeth

Gingivitis begins with the irritation of the gums by an acid, a by-product of bacteria ingesting food, resulting in an infection. The gums become inflamed, quickly bleeding and turning red. Gingivitis is reversible if treatment begins early.   However, if gingivitis is left untreated, it can advance to periodontitis.

Periodontitis (Periodontal disease) is an advanced gum disease involving gum tissue and supporting bone structure; if left untreated, can lead to tooth loss and promote some systemic diseases.

In healthy gums, the gum tissue and bone fit snugly around the neck of the tooth.  In periodontal disease tooth, the supporting tissue and bone are destroyed; a pocket forms around the neck of the tooth.  Without proper treatment, these pockets become larger and deeper, and more bacteria are invading.  As the pocket depth becomes greater than average, the supporting structures become weak and unable to hold the tooth firmly in the socket; the dentist may extract the tooth.

Symptoms of periodontitis are the same as gingivitis but more severe.  Some other clinical signs include:

1. Deep periodontal pockets in x-ray (gingival sulcus deeper than 3 mm)
2. Some degrees of tooth mobility in severe cases.
3. Receding gums
4. Loss of supporting bone structure around the root area
5. Focal or generalized small lumps and pus formation in chronic periodontal disease

Treatment:

Gingivitis  
Treatment for gingivitis includes scaling and polishing. A hygienist or dentist uses special tools called ultrasonic instrument and hand tools to remove plaque (tartar) builds up on the teeth without damaging the teeth surfaces.  Once finish the cleaning, a dental hygienist or dentist may polish the teeth with small rubber cup filled with prophylaxis paste.

Periodontitis or periodontal disease  
Treatment for the periodontal disease includes removing dental plaque and bacteria build up inside periodontal pocket to arrest and control the progress of periodontal disease.

1. For mild to moderate periodontal disease - a treatment of choice is performing scaling and root planing.  It is very useful in restoring the supporting structures to a healthy bone status provided the patient remains in maintenance program until the healing process completed.
   
   Scaling and root planing involve removing calculus, plaque, bacteria and infected material from the pockets around the root of the tooth.   The tools used are hand instruments and ultrasonic.


2. For medium to severe periodontal disease - the dentist may choose to do surgery.  Surgical treatment involves:
   
   • Removing pocket through gingivectomy
   • Re-shape the supporting bone crest to make it easy to maintain, resulting in healthy gum tissue and supporting structures


3. Maintenance therapy after surgery to help sustain periodontal health; this includes oral hygiene instruction at home:


• Rinse with Chlorhexidine or hydrogen peroxide for minimum of two weeks (Chlorhexidine needs prescription from your dentist)


• Brush with Curasept periodontal gel that contains Chlorhexidine Digluconate (need no medicine)


• Floss after each meal.  The best dental floss to use is Glide-Crest Dental Floss
  
  
• Use proxabrush to clean between the teeth after meals


• Use water irrigation to clean the teeth before bedtime.  Learn how to operate water irrigation correctly from this site.  Some recommended brands are Waterpik, Hydro Floss Oral Irrigator
  
  
• Avoid using toothpaste that contains Sodium Lauryl Sulphate, a detergent-like substance that can wash away Chlorhexidine


• Apply Gengigel gel or spray in the affected areas to stimulate the new bone growth and accelerate periodontal wound healing. 
  
  Gengigel promotes rapid remission of gingival and periodontal tissue.  This finding based on the study by T Ichikawa et al Osaka University, R Moseley et al University of Wales Dental School, R Pomowski, R gocke and H Jentsch, Rostock University, University of Leipzig, Germany


• Take Periostat (20 mg doxycycline hyclate - a member of tetracycline)  in conjunction with deep cleaning. Caution: Doxycycline reduces birth control pills effectiveness and may cause a permanent stain in children younger than eight years old.


4. Laser Assisted New Attachment Protocol (LANAP™) - A patented treatment of gum disease used in conjunction the Periolase dental laser system. 
   
   Robert H. Gregg ll, D.D.S and Delwin K. McCarthy, D.D.S, the founder of Millennium Dental Technologies, Inc. developed LANAP™ protocol in 1997.
   
   LANAP™ protocol involves using:
   
   
   • Laser light (PerioLase®MVP-7™) to kill bacteria in the pocket
   
   
   • Ultrasonic scaler to remove calculus
   
   
   • Complete with laser light (PerioLase®MVP-7™) to establish coagulation
   
   
   This modality has a short recovery (less than 24 hours), less trauma, bleeding, and pain.  LANAP™ is a better option for patients with heart disease, diabetes, high blood pressure or patients who routinely take Cyclosporine or Coumadin.
   
   
5. Perio Protect Treatment - Perio Protect uses a minimum invasive way to treat periodontal disease by delivering medication prescribed by a dentist to a particular location through a custom-made dental tray. The dental tray is fitting snugly over the teeth and gums, allowing the drug to reach target efficiently and prevent the medication from being washed away.  To find a dentist who is knowledgeable in Perio Protect method, click here.
   
   
6. Periowave -  a new technique using laser light combines with a photosensitizing solution to kill bacteria after deep cleaning.  The procedure is painless and quick.


7. Arestin - a form of tetracycline (Minocycline).  Arestin is in the powdered form that can be blown into the pocket by a plastic tube to kill bacteria in the dental pocket.  Arestin maintains its therapeutic property for approximately 21 days after administration.
   

Note: Common usages for Gengigel Gel are:

• Gingivitis, Periodontitis
• Lichen Planus
• Mouth ulcers
• Extraction wound

Directions: After brushing and flossing, apply Gengigel Gel and massage with cleaned finger over the inflamed area 3-4 times daily for 3-4 weeks

You may locate a periodontist in your area at perio.org

Gum disease can be prevented by:

1. Avoid eating starchy food such as cookies, bread, cakes, pasta made from white flour that can adhere to the teeth and becomes the nutrients for bacteria
2. Flossing every time after meals to remove any plaque or food remnants between the tooth
3. Brushing each time after meals with an electric toothbrush
4. Use water irrigation to clean deep around the gum area before bedtime every day
5. Rinse with Gengigel mouth rinses before bedtime every day

Water irrigation instruction:

1. Fill the tank with warm water to the level recommended by the manufacturer
2. Add a few drops of Listerine or other mouthwash of choice
3. Select the proper tip (the smaller tips are for those who have pockets as in periodontitis patients
4. Choose low pressure at the beginning
5. Place the tip facing the tooth, with 45 degrees to the gums.  This angle directs optimum water toward inside gum tissue
6. Increase the pressure slowly not too much that you experience pain, but enough to flush food particle out from inside the gum.  The irrigation also helps massage the gum and improve blood circulation
7. Move the tip around the gum line on each tooth, maintain 45 degrees angle until all teeth have been cleaned. Add more water if needed.

Note: Familiar yourself with water irrigation by moving the tip around the teeth without turning the water on in the beginning.

Home Remedies:
Some home remedies used to temporary stop gums bleeding, relieve pain, and swelling when immediate dental care with the dentist is not accessible;

1. Use probiotic capsule;
   
   • Remove the gel
   • Pour the powder content out from the capsule
   • Mix the powder with water until it becomes a paste-like consistency (make enough paste for all affected tooth); 
   • Apply the paste with finger or Q-tip to the affected gum area before bedtime. 
   
   Note:
   Do not rinse after applying the paste. There is no harm to swallow some. Wearing a  bleaching tray or mouth guard that has it's rim extending beyond the gum line keeps the paste in place longer. It is more efficient to apply the paste following flossing, brushing and using water irrigation.


2. Rinse with warm salt water
   Dissolve 1/2 teaspoon of salt in 8 ounces of water as hot as you can tolerate.  Rinse vigorously for 2-3 minutes every few hours.
3. Wash with Gengigel mouth rinses after flossing and brushing each meal


4. Rinse with dilute bleach (0.25 % sodium hypochlorite) twice weekly arrests the bleeding according to the Journal of Periodontal Research published on 21 July, 2014