Gingivitis
(Gum Disease · Periodontitis · Trench Mouth)
In this condition factsheet:
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 2 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
- poor-fitting fillings and crowns (also known as caps)
- mouth breathing
- genetics
- allergic reaction (e.g., cinnamon gum)
- vitamin C deficiency (scurvy)
- niacin (vitamin B3) deficiency (pellagra)
- medications (e.g., use of the female contraceptive pill)
- poorly aligned teeth or poorly fitted mouth appliances (such as retainers or crowns)
- exposure to heavy metals (e.g., lead, bismuth)
Pregnant people 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 people 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 (stoma is a medical term for "hole"). It only strikes people who have just caught herpes for the first time. Some genetic disorders or allergic reactions may also lead to gingivitis.
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 be the tip of the iceberg. It generally spreads between the teeth and gums, forcing the 2 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 cause bad breath. Eventually the teeth are no longer firmly fixed in position; they get loose and either fall out or have to be pulled out. This advanced form of gingivitis is called periodontitis. Surprisingly, it often causes no pain and the patient becomes aware of the disease due to bleeding gums or loose teeth.
Trench mouth, also known as Vincent's infection, is a particularly severe form of gingivitis caused by a combination of 2 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, severe pain, 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 found to affect those in times of severe stress (e.g., students during exam sessions) and 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 as premature birth, lung disease, heart disease, stroke, and heart attack.
