Gum disease can be plaque and bacteria related or it may be non-bacteria related.
A – Bacteria-related gum disease:
In this category, plaque bacteria are the main cause of gum disease:
Is when bacteria dominate the gum tissue around your teeth and as a result the gum becomes inflamed, this is called gingivitis. This inflammation is a natural defence mechanism from your body. It should be considered a signal that your body is giving, alerting you that you are under attack from bacteria.
How do I know if I have gingivitis?
There are signs and symptoms that you should watch for when suspecting gingivitis. One or a combination of one of these signs and symptoms may indicate gingivitis:
- Bleeding gums when brushing: It is usually difficult to understand where exactly the bleeding is coming from.
- Bleeding gums when using dental floss: Assuming you do floss correctly (not rubbing the floss between teeth), if you see bleeding from your gums while flossing, gingivitis is the most likely reason.
- Bleeding while using interdental brushes/toothpicks: When the gum is inflamed, cleaning between teeth with interdental brushes may cause bleeding if you have gingivitis.
- Bad breath
- Red and puffy gums (usually a purple/red band may show at the gum line around teeth
While bacteria remain the cause of gingivitis, there are circumstances that can present with gingivitis:
- Menstrual cycle
- Medications (some medications)
- Malnutrition and vitamin deficiencies
Gingivitis is generally reversible by appropriate treatment. However, if not managed properly, it can lead to a more serious condition called ‘Periodontitis’.
When gingivitis progresses and is not treated, the bacterial invasion leads to deeper inflammation in the gum. This leads to the supporting bone of the tooth getting affected. When this bacterial invasion dominates, the consequence is resorption and recession of the bone around the tooth.
Depending on the location and extent of the bacteria present deep at the gum line, the whole circumference of the bone may be affected or it can be localised to a smaller region around the tooth. As the bone is recedes down, the gum around the tooth follows that path.
The gum that is well attached to the root surface and lying over the bone, becomes detached from the tooth in the deep areas, this is when a periodontal pocket is formed. That is loose gum around the root of the tooth.
When the bone resorption (bone loss) around the tooth/root reaches a threshold, the tooth can gradually become mobile. The final consequence of periodontitis is severe bone loss and eventual loss of teeth.
Unfortunately, the disease process is usually painless. Therefore, periodontitis remains relatively silent for quite a long time until it may be too late.
The general signs and symptoms of periodontitis are the same as gingivitis. In addition there may be some other additional signs and symptoms that could be good indicators for periodontitis, these include:
- Feeling weakness with one or a few teeth in the mouth
- Constant and frequent food impaction between teeth
- Mobility of teeth (not readily felt usually)
- Hypersensitivity with cold and hot stimuli
- Migration of teeth
- Tenderness on teeth under pressure while chewing or biting
- Receding gums
What factors make me susceptible to Periodontitis?
From literature now we know that there are certain factors that may make some people more susceptible to periodontitis, these include but are not limited to:
- Genetics / Family history of gum disease:
If you have parents who lost their teeth at a young age, that may be an indication for genetic susceptibility
- Smoking (current or history of smoking):
Current and ex-smokers harbour bacteria in their mouth more specific towards gum disease. The changes occur over time and even after you quit smoking it tends to keep that effect for a very long time. Also, current smokers tend to have a compromised immunity against periodontal pathogens. Hence, the initiation and progression of periodontitis occurs in an easier way compared to never-smokers.
There is good evidence in literature supporting a poorer immunity response from bacterial attack in diabetics. This is particularly more pronounced in uncontrolled diabetes. Even short periods of glucose fluctuation may have an impact on progression of gum disease.
is one of the factors affecting immune response. Individuals may harbour periodontal pathogens and chronic stress may lead to compromised subclinical poor immune responses against bacteria, leading to the initiation and progression of gum disease.
- Plaque bacteria/poor oral hygiene:
The ultimate cause of periodontitis is bacteria. Even in the absence of any other risk factors, chronic poor oral hygiene can lead to the development of periodontitis.
- Vitamin D level:
There is substantial evidence that show low levels of Vitamin D, can be a contributing factor to the progression of periodontitis. Vitamin D has a strong role in immune response and its deficiency can compromise ones defence against bacteria.
- Irregular attendance to dentist/hygienist:
While good personal oral hygiene can eliminate most of the plaque bacteria from the surface of teeth, there is always a thin plaque bacteria accumulation around the gum line. These are the areas that are difficult to clean by individuals. Therefore, professional scaling and cleaning of teeth is required on a regular basis. Ideally, and for those with no history of periodontal disease the interval should best be 6 monthly. This interval is usually shorter when active periodontal disease is present and also after treatment in susceptible individuals.
- Poor dental state or poor restoration/denture state:
For example, the presence of multiple cavities on teeth can be a constant bacteria trap. This leads to bacteria growing constantly without being disturbed. Similarly, if dental fillings or a denture is made in a way that appropriate brushing is not possible, those sites will be at high risk of developing gum disease.
B – Non-bacteria related gum disease:
In this category, bacteria have no role in occurrence of the gum disease. The presentation of gum disease may be different than gingivitis. The causes include:
- Viral infections
- Allergic reactions
- Autoimmune disease with oral disease presentations
- Fungal infections
- Traumatic lesions (chemical, mechanical, thermal)
- Foreign body reaction
- Malignancies (cancer)