The Facts on Gingivitis

Gingivitis is an inflammation of the gums (known to doctors as the gingiva) caused by bacteria. Eventually the bacteria can get into the bones at the root of the teeth and eat them away. This latter stage is called periodontitis. It's a leading cause of tooth loss in the overall population and the number one cause in seniors.

Causes of Gingivitis

The bacteria that cause gingivitis lurk in the gum line, at the point where the teeth emerge. Many species of bacteria are involved, but they go by the universal name of plaque. Plaque is made of bacteria, mucus, and small particles of food. New bacteria are arriving constantly, and if they're not brushed off within about three days, they form a rock-hard layer called tartar. Toothbrushes and dental floss can't remove tartar, only a dentist can.

Some people are more prone to getting gingivitis than others. Gingivitis is particularly likely to occur in people with diabetes, AIDS, or leukemia. Other factors linked to an elevated risk of gingivitis include:

• puberty
• pregnancy
• menopause
• smoking
• vitamin C deficiency (scurvy)
• niacin (vitamin B3) deficiency (pellagra)
• use of the female contraceptive pill
• poorly aligned teeth or poorly fitted mouth appliances (such as retainers or crowns)

Pregnant women frequently have gum problems. Hormonal changes and tartar can combine to provoke an excess growth of gum tissue. Sometimes, a lump forms that may bleed easily. It's called a pregnancy tumour, though it has nothing to do with cancer. This lump can obstruct areas of gum line from brushing, letting bacteria prosper in safety.

Postmenopausal women can develop a painful condition called desquamative gingivitis. For unknown reasons, the outer layers of the gums come away from the teeth and lose their solidity. This disease can be very painful, as nerve endings are often exposed.

Some medications are also associated with gingivitis, including:

• cyclosporine* (used to treat rheumatoid arthritis and other autoimmune diseases)
• phenytoin (used to control epilepsy and other seizures)
• calcium channel blockers such as nifedipine (used treat high blood pressure and other heart conditions)

Some viruses can also infect the mouth. The one most likely to attack the gums is the herpes virus. It causes tiny ulcers and holes to appear in the gums and other parts of the mouth. This disease is called acute herpetic gingivostomatitis (a stoma is a medical term for "hole"). It only strikes people who have just caught herpes for the first time.

Symptoms and Complications of Gingivitis:

Typical bacterial gingivitis is usually a painless condition, even when the gums are bleeding. They become bright red and swell up. They are less firm than usual and may even be movable. They are likely to bleed during brushing and perhaps eating. Sometimes they bleed at night.

Herpetic gingivostomatitis also turns the gums bright red, but it can be easily distinguished because it's usually quite painful. There are dozens of tiny white or yellow sores visible in the gums and inner cheeks.

The tartar that can be seen at the gum line may represent the tip of the iceberg. It generally spreads between the teeth and gums, forcing the two apart and living in the newly created pocket. There, the bacteria release chemicals that can eat away at the bones that hold the roots of the teeth. These same chemicals may cause bad breath. Eventually the teeth are no longer firmly fixed in position and either fall out or have to be pulled out. This complication of gingivitis is called periodontitis. Surprisingly, it often causes no pain.

Trench mouth, also known as Vincent's infection, is a particularly severe form of gingivitis caused by a combination of two bacteria. Your dentist may refer to it by its other name, acute necrotizing ulcerative gingivitis (or ANUG). This disease causes a rapid onset of swelling, bleeding, and terrible bad breath. The gums are grey in colour, and are often misshapen. The papillae (the pointed part of the gum between the teeth) often become flat and have an area of dead tissue. The disease is usually only found in smokers. Its name dates back to the First World War when it often developed among soldiers in the trenches.

Gum disease has been linked to various health concerns such at premature births, lung disease, heart disease, strokes, and heart attacks.