Healthy gums are usually pink in color and do not bleed during tooth brushing or flossing. Gingivitis, or inflammation of the gums, is manifested by swollen, reddened gums that easily bleed during tooth brushing or flossing. The gums may be tender and painful to touch.
Inflammation is caused by bacteria that form a sticky biofilm (plaque) along the gumline, causing the gums to become reddened and swollen. Plaque is composed of bacteria, mucus, and food debris; if not removed, it turns into a hard deposit called tartar (or calculus), that is trapped at the base of the tooth, irritating the gums. Inflamed gum tissue may separate from the neck of the tooth, forming small gaps or pockets between the teeth and the gums. Bacte- ria settle in these pockets and produce digestive enzymes and endotoxins to promote inflam- mation.
If gingivitis proceeds unchecked, the pockets open up between the gums and the teeth, ex- posing the roots of the teeth. Bacteria may occupy those spaces and cause decay in the roots of the teeth. Periodontal disease develops when bacteria in the gum pockets adversely affect the periodontium, the specialized tissue that supports and maintains the teeth. Upon further inflammation and destruction of the periodontium, the teeth can gradually become loose and fall out or need to be removed. Persistent bad breath is an indicator of periodontitis.
Regular oral hygiene, including brushing and flossing, is the best defense against gingivitis. There is some evidence that flossing in conjunction with toothbrushing reduces gingivitis to a greater extent than toothbrushing alone. Other studies showed a greater reduction in plaque and gingivitis upon using powered/electric toothbrushes as compared to manual toothbrushes.
There is evidence that toothpaste containing fluoride is effective in preventing gingivitis. Mouthwashes with antimicrobial agents, such as hydrogen peroxide, triclosan, and chlorhexi- dine digluconate, are also effective therapies against gingivitis. Mouthwashes with essential oils, such as methyl salicyclate, eucalyptol, menthol, and thymol, were approved by the American Dental Association as plaque reducers and as anti-inflammatory agents. Mouthwash- ing with warm salt water may alleviate gum swelling.
Importance of Cleanings
Professional dental cleanings are required for removal of tartar, by scaling and root planning. Scaling is the procedure in which tartar and bacteria are removed from tooth surfaces and from beneath the gumline. Root planning is a more aggressive procedure that involves instru- mentation, a laser, or an ultrasonic device. These procedures remove bacterial metabolic products causing inflammation and smoothes root surfaces.
Young children may need supervision or assistance with their brushing technique. Older chil- dren and young adults may be more susceptible to gingivitis as they often have orthodontic appliances that make it more challenging to maintain proper oral hygiene.