Gums and gingivitis treatment

IMI Clinic

Which diseases afflict the gingiva, their causes, how to deal with them, and how to prevent them.

What is the gingiva and what does it look like?

The gingiva is the mucosal tissue that covers the bone and surrounds the teeth.

Near the crown the gingiva is coral pink and ends in a scalloped rim. It ends near the apex in the alveolar mucosa, which is a darker red. It is separated by a clearly visible boundary: the mucogingival junction.

The gingiva is composed of two parts: marginal gingiva and attached gingiva.

Marginal gingiva is coral pink, its surface is opaque, and its consistency compact.

The attached gingiva is marked at the apex by the mucogingival junction, from where it continues with the alveolar mucosa.

Near the crown is marginal gingiva: it is compact, coral pink, and often presents little depressions that make its surface puckered, almost like an “orange peel.”

 

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Gingivitis and periodontitis: typical diseases of the gums

Gums can host many clinical manifestations, as we will see below, but the most common disease of this area is certainly gingivitis and consequently periodontitis.

Most periodontal disease manifestations are connected to bacterial plaque. These ailments begin as an inflammation of the marginal gingiva: gingivitis. This can be considered a chronic inflammatory response to the accumulation of bacterial biofilm.

Healthy gingiva are plaque free: there are few white blood cells indicating a healthy condition. When plaque begins to increase, the junctional epithelium begins to recede. This means that the bacterial composition is changing, though Gram-positive and aerobic bacteria still prevail.

In the final stage of gingivitis, the established phase, the bacterial population has changed to Gram-negative accompanied by a lymphocytic inflammatory infiltrate.

All of these alterations are reversible because they do not produce a loss of attachment. For this reason, properly treated gingivitis always leads to a complete healing. However if these situations aren’t caught on time, the accumulation of bacteria continues, leading to periodontitis. This is caused both by the direct damage of the bacteria and by the indirect damage of the chronic inflammation.

For this reason it is very important to have a very scrupulous domestic oral hygiene, which should include the use of inter-dental aids. In this way it is possible to eliminate all residues of plaque. It is also highly recommended to have your teeth professionally cleaned once every 6 months.

 

heading

Gingivitis and periodontitis: typical diseases of the gums

Gums can host many clinical manifestations, as we will see below, but the most common disease of this area is certainly gingivitis and consequently periodontitis.

Most periodontal disease manifestations are connected to bacterial plaque. These ailments begin as an inflammation of the marginal gingiva: gingivitis. This can be considered a chronic inflammatory response to the accumulation of bacterial biofilm.

Healthy gingiva are plaque free: there are few white blood cells indicating a healthy condition. When plaque begins to increase, the junctional epithelium begins to recede. This means that the bacterial composition is changing, though Gram-positive and aerobic bacteria still prevail.

In the final stage of gingivitis, the established phase, the bacterial population has changed to Gram-negative accompanied by a lymphocytic inflammatory infiltrate.

All of these alterations are reversible because they do not produce a loss of attachment. For this reason, properly treated gingivitis always leads to a complete healing. However if these situations aren’t caught on time, the accumulation of bacteria continues, leading to periodontitis. This is caused both by the direct damage of the bacteria and by the indirect damage of the chronic inflammation.

For this reason it is very important to have a very scrupulous domestic oral hygiene, which should include the use of inter-dental aids. In this way it is possible to eliminate all residues of plaque. It is also highly recommended to have your teeth professionally cleaned once every 6 months.

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Gingival recession

Gingival recession is a movement of the gingival margin at the apex (cementoenamel junction). It is marked by a loss of gingival tissues, connective tissue and sometimes crestal bone.

Gingival recession coincides with a lengthening of the clinical crown of the tooth and the exposure of the root. This is not only an aesthetic drawback, but in most cases it also causes a problem of sensitivity to temperature and a predisposition to root cavities.

The etiology of gingival recession is multifactorial but incorrect brushing of the teeth may be considered the main cause, especially in individuals who present a good oral hygiene. We must not underestimate; dehiscence of the alveolar bone, elevated muscular insertions or fraenum traction, plaque or tartar or iatrogenic factors connected to periodontal and reconstruction techniques.

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Gingivitis and autoimmune diseases

Many systemic diseases, viral, bacterial infections or autoimmune diseases, can have gingival clinical manifestations.

They are not to be considered the majority of the alterations possible in this area, as we have already said gingivitis is the most common, but it is important to know they exist:

  • Herpes simplex can manifest on a gingival level in the form of clusters of little blisters that immediately become wounds.
  • Tuberculosis can have a nodular gingival manifestation that easily opens into a wound.
  • Candidiasis and severe mycosis.
  • Behcet’s disease, a complex systemic syndrome that can afflict all organs including the gingival. It includes complex autoimmune vasculitis, followed by an ischemic necrosis of the tissue.
  • Psoriasis, a chronic inflammatory skin disease, which in full-blown forms can present oral plaques similar to leukoplakia involving the gingiva in the form of desquamative gingivitis.
  • Linear igA bullous dermatosis, an autoimmune disease that causes blistering that can afflict the entire oral mucosa and frequently the gums.
  • Wegener’s Granulomatosis, an autoimmune vasculitis that can cause intense red gingival welts.
  • Leukemia is a neoplasia of the white blood cells. In 30% of cases it can present its first clinical sign a sudden increase in the volume of the adherent gingiva. The gingivae become an intense purple/red colour.
  • Some neoplasms, above all squamous cell carcinoma, can be localized in the gums. Though we must remember that the gums isn’t their usual location in the oral cavity.

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DSCN0063Gingival enlargement

Another alteration of the gums is hypertrophy, which means an increase in the volume of the gingival tissues.

Gingival enlargement can be the consequence of hormone alterations, therefore can appear during pregnancy. Alternatively it can be connected to the use of some medicines (antiepileptics, calcium channel blockers, immunosuppressive drugs) or associated to a chronic irritation due to removable prostheses for example.

The gingiva may present a different color in some areas, with spots that change from brown to black. This can be caused by the repeated consumption of some substances (wine, coffee, tobacco, certain medicines) or the exposure to some metals (led, bismuth, mercury).

In many of these alterations, the gingival lesions are just one of the manifestations of the disease.

We therefore have to cure the central ailment to observe an improvement of the oral cavity.

Gingival recession or gingivitis are strictly diseases of the gingiva.

It is important to adopt a correct approach to avoid worsening of the pathology and adopt preemptive measures to avoid the appearance of the disease entirely. For this reason it is important to go to the dentist regularly, as they will be able to identify these conditions and suggest the correct measures that should be adopted.

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