Gingivitis vs. Periodontitis
Gingivitis and Periodontitis: What is it ?
We speak about gingivitis when inflammation is limited to the gums. An unbalance of the oral bacterial flora will cause an inflammation. The gum appears red, swollen and bleeding.
It is the initial phase of infection, untreated it can evolve to periodontitis which is the main cause of tooth loss in adults.
When the situation worsens, we are in periodontitis. Inflammation evolves towards the periodontium. The supporting tissues of the tooth will be destroyed, revealing the root of the tooth causing its mobility and its fall.
From Gingivitis to Periodontitis :
In the normal state, our mouth contains non-virulent bacteria that live in harmony with our immune system. Once the balance is broken by various reasons, especially the neglect of our oral hygiene, the pathogenic bacteria will proliferate and associate forming the bacterial plaque. The plaque sticks to our teeth and can turn into tartar if it is not removed. Tartar is more difficult to remove and requires the help of the dentist. This bacterial depot attacks our gums by releasing toxins causing inflammatory reactions: it is gingivitis. The gum becomes red, swollen and bleeding.
At this stage, the disease is reversible by a simple control of plaque. If gingivitis is not treated, the inflammation will progress in depth affecting the supporting tissues of the tooth: it is periodontitis. In addition to the inflammatory signs of the gum, there is irreversible tissue destruction. There is loss of gingiva revealing the root of the tooth, destruction of the fibers that attach the tooth to the bone, causing mobility and loss of teeth. A particularity of periodontitis are the periodontal pockets, they form a gap between the tooth and the gum, it is abnormally deep and constitutes a favorable environment for the development of pathogenic bacteria and the storage of tartar, hence the speed of evolution of the lesion. In addition to local effects, general health can be influenced. The bacteria in the pockets below the gums will spread throughout the body through the bloodstream. People with periodontitis may be prone to cardiovascular problems. Pregnant women are at risk of premature birth or giving birth to a low weight baby. In diabetics, untreated periodontitis makes glycemic control more difficult and the patient may experience complications.
Gingivitis to Periodontitis: What are the risk factors ?
The transition from gingivitis to periodontitis is the result of the breakdown of the balance between bacterial plaque and immune defense.
This stability can be disrupted by various factors including the persistence of bacterial plaque, tobacco, stress, infections and some drug-Induced disorders.
Persistance of bacterial plaquePlaque is a bacterial deposit adhering to the teeth capable of turning into tartar more adherent and more resistant. The persistence of the plaque will amplify inflammation leading to progression to periodontitis.
StressStress is a factor that aggravates gum disease. Patients with inadequate stress behavior strategies are at greater risk for severe periodontal disease. Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance, and potentially increased risk of gum disease. Men who reported being angry on a daily basis had a 43% higher risk of developing gum disease compared with men who reported being angry seldom.
SmokingSmokers present compared to non-smokers:
- 6 times more risk of develop gum disease.
- More periodontal pockets (advanced sign of periodontal diseases).
- More gum recessions (the exposure in the roots of the teeth caused by a loss of gum tissue).
- More bone loss.
- More dental loss.
- Less gum bleeding (which can mask early signs of gum disease).
InfectionsCertain viruses such as Human Immunodeficiency Virus (HIV) can cause periodontal diseases by weakening our immune system.
Epidemiological studies have shown that HIV-infected populations compared to non-HIV-infected populations have more bone lysis and more gingival recessions.
Drug-induced DisordersSome medications significantly decrease salivary flow which is not good because of the protective role of saliva. These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives and antihistamines.
Other drugs, particularly those in liquid or chewable form that contain added sugar, alter the pH and composition of plaque, making it more able to adhere to tooth surfaces.
Drugs can be a contributing factor in gum diseases. Drugs such as nifedipine, cyclosporin and phenytoin induce gingival swelling.
PreventionDental plaque is made up of different types of bacteria that establish connections between them in order to survive and increase their virulence factor. It must be eliminated before any treatment because it is considered the main factor of gingivitis.
A good control of plaque makes it possible to reverse gingivitis. It allows the gum to regain its normal appearance and prevent gingivitis from becoming irreversible periodontitis.
If you notice that your gum is abnormal (if your gums bleed when flossing, brushing, or simply when you bite into an apple), it is probably the early stage of gingivitis.
The first thing you need to think about is to eliminate the bacterial plaque.
I recommend you to:
- Brush your teeth 2 times a day for at least 3 minutes, with a good brushing technique and a soft bristle toothbrush to avoid hurting your gum. Brushing prevents the film that covers the teeth from becoming plaque, which is more difficult to remove.
- Floss your teeth once a day. Flossing helps you to eliminate 30% of the remaining plaque between the teeth, inaccessible to brushing. You can also use an interdental brush if your teeth are not tight. Oral irrigator will also be effective. A study has shown that oral irrigator reduces inflammation of the gums.
- Ask your dentist if you should use a mouthwash. The mouthwash is an antiseptic solution that eliminates aggressive bacteria from our mouth responsible for gingivitis. But the mouthwash should not be used continuously, hence the importance of seeking the advice of your dentist.
- Stop smoking. Tobacco is a risk factor for gum disease. Stopping smoking improves periodontal health.
- Control your general health. Some diseases aggravate gingivitis especially diabetes, some infections and hormonal modifications.