<strong>Gum Problems</strong>
Gum Problems

A change in the balance of bacteria that reside in the mouth and the accumulation of oral biofilm (bacterial plaque) can cause gingival inflammation and bleeding, and lead to gum disease that develops both when teeth are present (gingivitis and periodontitis) and when dental implants are present (peri-implant mucositis and peri-implantitis).

Gingivitis is a reversible disease that is characterized by gingival inflammation and that affects the soft tissues. It does not affect the tooth support tissues. If gingivitis is not kept under control, it can develop and become periodontitis, a disease that spreads to the deepest parts of the tooth (periodontal ligament and tooth-supporting alveolar bone), and may lead to tooth loss.

According to the Spanish Society of Periodontology and Osseointegration, gingivitis and periodontitis are two of the most common diseases. They have a prevalence in adults between the ages of 35 and 44 of 59.8% and 25.4% and in patients between the ages of 65 and 74 of 51.6% and 38%, respectively. More than half of the Spanish population over 35 years of age has had gingivitis at some time, and one in three have had periodontitis.

ORIGIN

Gum disease is caused by the accumulation of oral biofilm, which is the main etiological agent of periodontal diseases (gingivitis and periodontitis) and peri-implant diseases (peri-implant mucositis and peri-implantitis).

CAUSES

Several factors exist that may favor the onset of gingivitis.

  • Gingivitis associated with local factors: generally associated with inadequate oral hygiene, tooth malposition, occlusal trauma, overcontoured fillings, fixed and removable orthodontics and removable and fixed prostheses (bridges and crowns), with these last two possibly causing irritation to the gums and increasing the risk for gingivitis.
  • Gingivitis caused by systemic factors: some gingivitis are related to the endocrine system. These include those that are associated with pregnancy, puberty, menstrual cycle and uncontrolled diabetes, among others.
  • Drug-induced gingivitis: as a consequence of consuming certain drugs.
  • Gingivitis caused by malnutrition: sometimes gingivitis can be associated with nutritional deficits. 

If the gingivitis condition develops, it can evolve to become periodontitis. In this case, the inflammation of the gums spreads to deeper areas of the tooth (periodontal ligament, connective tissue and alveolar bone).

Situations that put patients at risk for periodontitis include smoking, physical or emotional stress, hormonal changes (puberty, pregnancy, menopause), drugs, such as contraceptives and corticosteroids, acute infections and chronic diseases such as diabetes.

DIAGNOSIS

The diagnosis of gum diseases is done through observation, making it easy for patients themselves to detect the problems. When gingivitis is present, gingival redness, inflammation and bleeding are usually observed. If bleeding exists, it is necessary to visit the dentist to rule out possible complications and so that he/she can recommend the most appropriate treatment. Periodontitis is characterized by gingival redness, inflammation, bleeding and recession, tooth mobility and the loss of tooth-supporting alveolar bone.

DENTAL TREATMENT

The prevention and treatment of these periodontal and peri-implant (caused by deterioration of the tissues surrounding implants) diseases must focus on the application of anti-infectious measures. The aim is to mechanically disrupt the oral biofilm (bacterial plaque) and reduce the number of bacteria that cause disease to levels that are compatible with health. In order for this to occur, combined treatments must be performed, including mechanical and chemical treatment. Mechanical treatment with toothbrushes helps to disrupt the oral biofilm; however, there are certain limitations with this in non-compliant patients. This is why the use of antiseptics, such as Chlorhexidine and Cetylpyridinium Chloride, is essential as a chemical adjunct to the mechanical treatment for controlling oral biofilm

Antiseptics such as Chlorhexidine, the gold standard of antiseptics1 and others, such as Cetylpyridinium Chloride, are agents that exert anti-gingivitis and anti-plaque effects. Not all mouthwashes containing Chlorhexidine have the same efficacy, since this depends on the formula. The alcohol-free combination of 0.12% Chlorhexidine and 0.05% Cetylpyridinium Chloride is indicated for specific situations like periodontitis1 and peri-implantitis2. Numerous publications back it as the most effective antiseptic formula3

Chlorhexidine at low concentrations (0.05%) combined with 0.05% Cetylpyridinium Chloride can be recommended for daily use to control periodontal disease recurrence, especially in non-compliant patients, as well as in less complex situations

If you observe changes in your gums, it is essential that you visit your dentist as soon as possible. Examination and treatment will be the key to restoring healthy gums and preventing the evolution of disease. This is important because periodontal infection can increase the risk for certain systemic diseases such as diabetes, cardiovascular diseases, respiratory diseases, rheumatoid arthritis and complex situations including preterm delivery and low birth weight babies.

Periodontal disease during pregnancy

During pregnancy, the hormonal and physiological changes in women can exacerbate minor complications in the oral cavity, causing the onset of periodontal diseases such as gingivitis, which, without proper treatment, can evolve into periodontitis. During the months of pregnancy vascular permeability augments, leading to an increased transfer of periodontal pathogens and pro-inflammatory signals from the tooth surface to the bloodstream, ultimately spreading systemically and affecting the placenta and increasing the risk for the development of complications for an unborn child.

Placental inflammation and infection can cause adverse pregnancy outcomes such as pre-term delivery (before pregnancy week 37), low birth weight (below 2,500 grams) or pre-eclampsia/eclampsia (associated with labour-induced hypertension and with elevated urine protein levels).

Currently, between 60 and 75% of pregnant women have gingivitis during their pregnancies, a condition known as pregnancy gingivitis, which tends to worsen after the second trimester. 50% of women who have gingivitis prior to becoming pregnant may experience a worsened periodontal state and even come to have periodontitis.

Prevention is the key for reducing the prevalence of gingivitis and for preventing its progression to periodontitis in pregnant women. During pregnancy it is advisable to pay special attention to daily oral hygiene by physically controlling oral biofilm, with a toothbrush that is specifically designed for gum care and with interproximal hygiene tools, and by chemically controlling this biofilm using toothpastes and mouthwashes that contain antiseptics that are deemed safe and effective during pregnancy, such as Cetylpyridinium chloride (CPC).

References

- Jones C. (1997). "Chlorhexidine: is it still the gold standard?". Periodontology 2000; 15, 55-62

- Herrera D, Roldán S, Santacruz I, Santos S, Masdevall M, Sanz M. “Differences in antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinse formulations: an in vitro contact test and salivary bacterial counts study”. J Clin Periodontol. 2003 Apr; 30 (4):307-14

- García D. y López M. (2010). "Interacciones farmacológicas en periimplantitis". Journal of the American Dental Association; Vol.5 nº 1.

- Quirynen M., Avontroodt P., Peeters W., Pauwels M., Coucke W., van Steenberghe D. (2001). "Effect of different chlorhexidine formlations in mouthrinses on de novo plaque formation". Journal of Clinical Periodontology; 28:1127-36).

- Escribano M., Herrera D., Morante S., Teughels W., Quirynen M., Sanz M. (2010). "Efficacy of a low-concentration chlorexidine mouth rinse in non-compliant periodontitis patients attending a supportive periodontal care programme: a randomized clinical trial". Journal of Clinical Periodontology; 37: 266-275.

- Silk et al. Oral health during pregnancy. Am Fam Physician. 2008;77:1139-44.

- Madianos PN, Bobetsis YA, Offenbacher S. Adverse pregnancy outcomes (APOs) and periodontal disease: pathogenic mechanisms. J Clin Periodontol 2013; 40 (Suppl. 14): S170–S180.

- Santacruz I. Enfermedad periodontal y alteraciones en el embarazo. En: II Simposio SEPA-DENTAID. Madrid; 2014.

- Curiel E, Prieto MA, Muñoz J, Ruiz de Elvira MJ, Galeas JL, Quesada G. Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obstétrica. Med Intensiva. 2011;35(8):478-483.

- American Dental Association Council on Access, Prevention and Interprofessional Relations. Women’s oral health issues. American Dental Association, 2006.

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