GUM DISEASE

IMI Clinic

What is a typical gum disease? What causes these diseases? How can these diseases be prevented and which gum disease treament therapies are viable?

What are the gums made up of?

The gingiva is the part of the masticatory mucous membrane that covers the bone and surrounds the tooth neck of the dental elements, and it is different for each of us.

Towards the crown of the tooth, the gums appear to have a red-choral colour and ends and with the gingival margin, which has a scalloped edge. Towards the apex, the gums continue on with the alveolar mucosa, which is a deeper colour of red, and it separated by a border that is easily recognizable: it’s called the mucogingival line.

The gingiva can be separated into two parts: the free gingival margin and the attached gums.

The free gingival margin has a red choral colour, an opaque surface and a compact consistency.

The attached gums are bound towards the apical of the mucogingival junction, where the alveolar mucosa continues.

The coronal portion of the tooth continues on with the free gingival margin: it has a compact consistency, a pink colour and has small impressions that gives it a pointy surface, making it almost look like an “orange peel.”

Gingivitis and periodontitis: typical gum diseases

The gums can be home to numerous clinical manifestations, that we will discuss in further detail in the paragraph below, but gingivitis (which then later on becomes periodontitis) is definitely the most common disease in this area of the body.

The majority of the different types of periodontal diseases are usually caused by irrigations due to bacterial plaque. These diseases start out as inflammations of the marginal gums: gingivitis, from this stance, can be considered a chronic inflammatory response due to the accumulation of supragigival biofilm.

Healthy gums don’t have an accumulation of plaque: rather, they have a low white blood count, which is a sign that they are healthy. The accumulation of plaque causes the junctional epithelium to retract; in healthy gums the junctional epithelium doesn’t react : that means that the bacterial composition is changing, even if Gram+ and aerobe bacteria were not yet prevalent in that area.

In the final stage of gingivitis, it has settled in and the bacterial population has mutated and it enriches itself with Gram-, with a lymphocytes type of inflammatory infiltration.

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Each and every one of these types of changes that we’ve mentioned above are always reversible, because, while the disease is still in the gingivitis stage, the gingivae do not get detached from the teeth, and as long as the disease is properly treated, then gums can completely heal. If however, these types of situations aren’t intercepted, then bacterial accumulation will continue to evolve into periodontal disease, which is caused both by direct damage provoked by bacteria, and by indirect damage produced by a chronic inflammatory response.

Therefore, it’s very important to take the extra time to ensure that you have a good at-home oral hygiene routine (which includes the use of dental floss). That way, it’s possible to eliminate as much residual plaque as possible. Additionally, we highly recommend that you get a professional teeth cleaning at least every 6 months.

A receding gum line

A receding gum line happens when the gum line margin moves apical to the Dental-Enamel Junction (DEJ). It’s characterized by gingival tissue loss, connective tissue loss, and sometimes crestal bone loss.
Receding gums coincide with the lengthening of the clinical tooth crown and determines the anatomical conditions of root exposure of the surrounding oral environment: not only does this cause aesthetic problems, but also almost always causes problems with sensitivity of the thermal stimuli and may also possibly cause predisposition to root cavities.

The multifactorial aetiology of gingival recession and improper tooth brushing are to be considered the main causes of recession development, especially with those that have good oral hygiene. Alveolar bone dehiscence, muscle insertions, high frenula traction, plaque, tartar and iatrogenic factors correlated to periodontal reconstructive techniques should not to be underestimated.

Gingivitis and autoimmune diseases

Many systemic diseases, viral and bacterial infections, or autoimmune diseases may clinically manifest themselves in the gingivae.

Of course, this doesn’t represent the majority of the changes that were encountered in the scenario we’ve described above when we talked about the gums and the most common oral pathology, but it’s important to also know that the following diseases also exist:

  • Herpes simplex can have manifest itself in the gums by forming colonies of small blisters and then immediately turn into erosions.
  • Tuberculosis can manifest itself in the gums that look like nodular type boils that easily erode
  • Thrush and deep mycoses
  • Behcet’s syndrome is a complex multisystem disease that can affect any organ and the gums with an autoimmune thrombotic vasculitis caused by immune complexities that is followed by an ischemic necrosis of the affected tissue.
  • Psoriasis, which is a chronic inflammatory skin disease, which may overtly show up in the form of oral leukoplakia lesions involving the gums that present themselves in the form of desquamative gingivitis
  • igA disease gives off linear igA deposits, it’s an autoimmune disease that shows up through blisters that evolve into erosions that can entirely affect the oral mucosa and most frequently the gums
  • Wegener’s Granulomatosis or also known as Granulomatosis with Polyangiits (GPA) which is an autoimmune vasculitis that has an intense red color and can cause gum swelling
  • Leukemia which is a cancer of the white blood cells that may, in 30% of the cases show, as the first clinical sign, a sudden increase in volume of the attached gingiva. The gums appear to be a deep red / purple in colour
  • Some cancers, especially squamous cell carcinoma, may also have gingival localization, however, it should be noted that among the several areas of the oral cavity, this is not what we want

Gingival Hypertrophy

Gum disease treatment

Another gum alteration is hypertrophy, which manifests itself in the form of an increase in the volume of the gum tissues.

Gingival hypertrophy can be a consequence of hormonal changes and therefore can appear during pregnancy, can be tied to certain medications (antiepileptics, calcium channel blockers, immunosuppressants) or be actually associated to chronic irritation caused by, for example, removable prosthetics.

The gums can vary in colour in different areas of the mouth (pigmentations) with spots that go from being brown to black which can be associated to the repeated consumption of certain substances (wine, coffee, tobacco, and some mediations) or due to the exposure of certain metals (lead, bismuth, mercury).

For many of these alterations, gum lesions are only one of the many possible clinical manifestations of the disease: therefore, in order to improve oral conditions, the main disease that is causing all of these oral issues must first be treated.

However, when it comes to gingivitis and a receding gum line, which are, on the other hand, diseases that stem from the gums, it’s important to properly treat the mouth so that the disease isn’t aggravated and whenever possible, prevent the disease from spreading. That’s why it’s important to routinely visit the dentist, so that he or she may identify these conditions and suggest a proper treatment plan.

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