Gingivitis, also called gum disease or periodontal disease, describes the events that begin with bacterial growth in the mouth and may end — if not properly treated — with tooth loss from destruction of the tissue that surrounds and supports the teeth. Gingivitis and periodontitis are two distinct stages of gum disease.
Gingivitis usually comes before periodontitis. However, it is important to know that not all gingivitis progresses to periodontitis. In the early stage of gingivitis, bacteria in plaque build- up and cause the gums to become inflamed (red and swollen) and often bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
When gingivitis is left untreated, it can advance to periodontitis. In a person with periodontitis, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets. These small spaces between teeth and gums collect more bacteria and debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line.
Toxins, or poisons, produced by the bacteria in plaque as well as the body’s “good” enzymes (involved in fighting infections), turn against the body and actually start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, in fact, is the leading cause of tooth loss in adults.
Plaque is the primary cause of periodontal disease. However, other factors can contribute and advance the gum disease. These include:
Hormonal changes, such as those occurring during pregnancy, puberty, menopause, and monthly menstruation, make gums more sensitive. Thus makes it easier for gingivitis to develop.
Illnesses, which may affect the condition of the gums. This includes diseases, such as cancer or HIV, that interfere with the immune system. Because diabetes affects the body’s ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.
Medications can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums.
Bad habits, such as smoking, make it harder for gum tissue to repair itself by upsetting the balance of repair and breakdown of oral tissues.
Poor oral hygiene habits, such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop resulting in a buildup of soft bacteria and calculus (tartar).
Family history of dental disease can be a contributing factor in the development of gingivitis.
• Bad breath
• Red or swollen gums
• Tender or bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth
• Receding gums or longer appearing teeth
The dentist or periodontist typically checks:
Gums: for bleeding, swelling, firmness, and measurement of the periodontal pockets (the space between the gum line and the attachment to the bone; the larger and deeper the pocket, the more severe the disease)
Teeth: for movement and sensitivity
Bite: for proper teeth alignment
Jawbone: (uses X-rays) to help detect the breakdown of bone surrounding the teeth
The goals of periodontal treatment are to promote reattachment of healthy gums to teeth; reduce swelling, the depth of pockets, and the risk of infection; and to stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments, and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues.
Deep Cleaning (Scaling and Root Planing): The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases, a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.
Medications: Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time.
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.
Gingivitis can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached. Flossing removes food particles and plaque from in between the teeth and under the gum line.
Other health and lifestyle changes that will decrease the risk, the severity, and the speed of gum disease development include the following:
Stop smoking. Tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.
Decrease stress. Stress may make it difficult for body’s immune system to fight off infection.
Maintain a well-balanced diet. Proper nutrition helps the immune system fight infection. Eating foods with antioxidant properties—for example, those containing vitamin E (including vegetable oils, nuts, green leafy vegetables) or vitamin C (including citrus fruits, broccoli, potatoes) can help your body repair damaged tissue.
Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.
For many years, the only treatment options available for people with missing teeth were bridges and dentures. Today, dental implants are available.
Dental implants are titanium replacements of tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.
In most cases, anyone healthy enough to have a routine dental extraction (having a tooth pulled) or oral surgery can be considered for an implant procedure. Patients should have healthy gums and enough bone to hold the implant. They also must continue to practice good oral hygiene and have regular dental visits.
Heavy smokers, people who have uncontrolled chronic disorders (such as diabetes or heart disease), or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis.
Dental implants can greatly enhance a person’s quality of life by providing the following:
• Restoring normal chewing and speaking functions
• Eliminating irritated and painful gums, as well as damaging pressure on remaining natural teeth caused by dentures
• Helping to stop the progressive bone loss and shrinkage of your jawbone by “mimicking” the roots of natural teeth
• Improved appearance. Dental implants look and feel like your own teeth. Because they are designed to fuse with bone, they become permanent.
• Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that your teeth might slip.
• Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
• Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
• Improved self-esteem. Dental implants can give you back your smile, and help you feel better about yourself.
• Improved oral health. Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not changed to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
• Implants are very durable and will last many years. With good care, many implants last a lifetime.
• Removable dentures are just that; removable. Dental implants can eliminate the embarrassing inconvenience of removing your dentures, as well as the need for messy adhesives to keep your dentures in place.
Oral and maxillofacial surgeons will conduct an evaluation to determine if the patient is an appropriate candidate for dental implants. Patients who receive dental implants must be in good health, have a healthy lifestyle and healthy gums, adequate bone to support implants and be committed to excellent oral hygiene and regular dental visits.
The first step in the process is the development of an individualized treatment plan. The plan addresses your specific needs and is prepared by a team of professionals who are specially trained and experienced in oral surgery and restorative dentistry. This team approach provides coordinated care based on the implant option that is best for you.
Next, the tooth root implant, which is a small post made of titanium, is placed into the bone socket of the missing tooth. (More often, some bone grafting is done to fill the socket of the missing tooth; after that has healed, the implant is placed. This is done to make sure the implant is placed in as ideal a location as possible, to make the restoration look as natural as possible.) As the jawbone heals, it grows around the implanted metal post, attaching it securely in the jaw. The healing process can take from 6 to 12 weeks.
Once the implant has bonded to the jawbone, a small connector post – called an abutment – is attached to the post to securely hold the new tooth. To make the new tooth or teeth, the dentist makes impressions of the teeth, and creates a model of the bite (which captures all of the teeth, their type, and arrangement). The new tooth or teeth are based on this model. A replacement tooth, called a crown, is then attached to the abutment.
Instead of one or more individual crowns, some patients may have attachments placed on the implant that hold and support a removable denture.
Success rates vary, depending on where in the jaw the implants are placed. In general, dental implants have a success rate of up to 97%. With proper care, implants can last a lifetime.
Thrush is an infection of the mouth caused by the Candida fungus, also known as yeast. Candida infection can occur in other parts of the body as well, causing diaper rash in infants or vaginal yeast infections in women.
Small amounts of the Candida fungus are present in the mouth, digestive tract, and skin of healthiest people. They are normally kept in check by other bacteria and microorganisms in the body. However, certain illnesses, stress, or medications can disturb this balance, causing the fungus Candida to grow out of control and cause infection.
Thrush can affect anyone, though it occurs most often in babies and toddlers, older adults, and people with weakened immune systems.
Examples of medications that upset the balance of microorganisms in the mouth include corticosteroids, antibiotics, and birth control pills.
Factors that make Candida infection more likely to develop include uncontrolled diabetes, HIV infection, cancer, dry mouth, pregnancy (caused by the hormonal changes that occur with pregnancy), smoking and dentures that don’t fit properly. In addition, babies can pass the infection to their mothers during breast-feeding.
While healthy children and adults can be effectively treated, the symptoms may be more severe and difficult to manage in those with weakened immune systems.
The dentist can make the diagnosis by examining the mouth, by looking for the distinctive white lesions on the mouth, tongue, or checks. Lightly brushing the lesions away reveals a reddened, tender area that may bleed slightly. A microscopic examination of tissue from a lesion can confirm the diagnosis.
Thrush that may extend into the esophagus may require other tests to make the diagnosis. Such tests might include:
• Taking a throat culture (swabbing the back of your throat with sterile cotton and studying the microorganisms under a microscope).
• Performing an endoscopy of the patient’s esophagus, stomach, and small intestine (examining the lining of these body areas with a lighted camera mounted on the tip of a tube passed through these areas).
• Taking X-rays of the esophagus.
Antifungal medications, which are generally taken for 10 to 14 days, are often prescribed to treat thrush. These medicines are available in tablets, lozenges. Because the presence of Candida infection can be a symptom of other medical problems, the dentist may refer to a medical doctor so that any underlying health problems can be treated.
The following practices can help the patient avoid developing thrush:
• Good oral hygiene practices: Brush the teeth at least twice a day and floss at least once a day.
• Avoidance of mouthwashes or sprays: These products can destroy the normal balance of microorganisms in your mouth.
• Regular visit to the dentist: This is especially important in case of diabetes or wear dentures.
• The amount of sugar and yeast-containing foods should be limited: Foods such as bread, beer, and wine encourage Candida growth.
• Quit smoking
Oral cancer includes cancers of the mouth and the back of the throat. Oral cancers develop on the tongue, the tissue lining the mouth and gums, under the tongue, at the base of the tongue, and the area of the throat at the back of the mouth.
Oral cancer most often occurs in people over the age of 40 and affects more than twice as many men as women. Most oral cancers are related to tobacco use, alcohol use (or both), or infection by the human papilloma virus (HPV).
Mouth cancer can occur on the:
• Inner lining of the cheeks
• Roof of the mouth
• Floor of the mouth
Cancer that occurs on the inside of the mouth is sometimes called oral cancer or oral cavity cancer. Mouth cancer is one of several types of cancer grouped in a category called head and neck cancers.
Tobacco and alcohol use. Tobacco use of any kind, including cigarette smoking, puts you at risk for developing oral cancers. Heavy alcohol use also increases the risk. Using both tobacco and alcohol increases the risk even further.
HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to oral cancers.
Age. Risk increases with age. Oral cancers most often occur in people over the age of 40.
Sun Exposure. Cancer of the lip can be caused by sun exposure.
Diet. A diet low in fruits and vegetables may play a role in oral cancer development.
• A sore, irritation, lump or thick patch in the mouth, lip, or throat
• A white or red patch in the mouth
• A feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Swelling in the jaw
• Numbness in your tongue or other areas of the mouth
• Pain in one ear without hearing loss
Tests to diagnose oral cancer include a physical exam, endoscopy, biopsy, and imaging tests. Because oral cancer can spread quickly, early detection is important.
When oral cancer is detected early, it is treated with surgery or radiation therapy. Oral cancer that is further along when it is diagnosed may use a combination of treatments.
For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy, which is a newer type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. The choice of treatment depends on the general health, where in the mouth or throat the cancer began, the size and type of the tumor, and whether the cancer has spread. Referral to a specialist should be advised.
Specialists who treat oral cancer include:
• Head and neck surgeons
• Dentists who specialize in surgery of the mouth, face, and jaw (oral and maxillofacial surgeons)
• Ear, nose, and throat doctors (otolaryngologists)
• Doctors who specifically treat cancer (medical and radiation oncologists)
• Other health care professionals who may be part of a treatment team include dentists, plastic surgeons, reconstructive surgeons, speech pathologists, oncology nurses, registered dietitians, and mental health counselors.
- Cleveland Clinic. Gingivitis and Periodontal Disease (Gum Disease), 2017. Available at: https://my.clevelandclinic.org/health/diseases/10950-gingivitis-and-periodontal-disease-gum-disease
- National Institute of Dental and Craniofacial Research. Periodontal (Gum) Disease. NIH Publication No. 13-1142 September 2013
- Cleveland Clinic. Dental Implants, 2016. Available at: https://my.clevelandclinic.org/health/treatments/10903-dental-implants
- University of California San Francisco (UCSF). Dental Implants. Available at: https://www.ucsfhealth.org/treatments/dental_implants/
- Cleveland Clinic. Thrush, 2017. Available at: https://my.clevelandclinic.org/health/diseases/10956-thrush
- National Institute of Dental and Craniofacial Research. Oral Cancer, 2018. Available at: https://www.nidcr.nih.gov/health-info/oral-cancer/more-info
- Mayo Clinic. Mouth Cancer, 2017. Available at: https://www.mayoclinic.org/diseases-conditions/mouth-cancer/symptoms-causes/syc-20350997