Gum Treatments

What Is the Gum?

The gum is a soft tissue in the mouth that covers the alveolar bone (the bone that supports the teeth) and encloses the base of the teeth to keep them in place.

Two types of gums are present in the mouth: the attached gum, which supports the teeth, and the free mucous membrane. The free mucous membrane is the upper part of the gums, which is not attached to the teeth. We will focus here on the attached gum.

During a dental examination, special attention is paid to your gums, which are essential for the maintenance of your teeth. Since they are particularly sensitive by nature, they are vulnerable and can easily develop various diseases and infections. By making an appointment with your dentist, you can make sure you prevent these at the source.

Healthy gums are characterized as follows:

⦁ It is pink and firm, has a texture similar to an orange peel and it sticks completely to the teeth;
⦁ Its volume allows it to adequately support the teeth;
⦁ It is neither red nor swollen (which may indicate the presence of inflammation);
⦁ It does not bleed on contact with the toothbrush or dental floss;
⦁ It covers the tooth in a way that hides the root.

What Is Periodontium?

The periodontium consists of the tissues that support the teeth, including:

⦁ the gum (18, 19, 20, 21);
⦁ Alveolar bone (23): part of the jawbone in which the teeth are implanted;
⦁ Cementum (7): Protective layer that covers the tooth root in the alveolar bone;
⦁ the periodontal ligament (22) : tissue that surrounds the root of the tooth and is located between the cementum and the alveolar bone;
⦁ nervous elements and blood vessels near the tooth.

A healthy periodontium helps protect and adequately surround the teeth. When the periodontium is affected, it cannot fulfill its protective role. The roots of the teeth can then be exposed, become unstable and be more vulnerable to infections. In the most serious cases, a periodontium in bad health can lead to the loss of teeth.

A regular visit to your dentist can detect periodontal health problems. It is thus possible, thanks to a complete examination, to prevent the damage which can take place when your periodontium begins to present one or more problems.

Gum Diseases

According to the Canadian Dental Association (CDA), gum disease is the most common dental problem. Their development can be insidious. The slow progression of the disease and the absence of pain at the onset of the disease means that the affected person is often unaware of it.

The good news is that gum disease, although it can cause significant damage, can very often be prevented or treated when detected at an early stage.

Early detection of disease and the provision of immediate care will often save you from more complex and costly procedures. It is even possible to treat the onset of an illness or infection before you experience symptoms, sparing you the discomfort and pain that might otherwise be experienced.

However, when the disease is more advanced, you risk much more serious consequences. Chronic problems, severe pain and chewing difficulties are among them. At an even more advanced stage, it can even lead to tooth loss.

Risk Factors

Several factors must be considered in order to determine the probability that a person develops a periodontal disease. These factors may depend on your dental hygiene and habits, but also on natural and biological factors over which you do not have control. Your dentist will be able to inform you about your predispositions and give you advice to avoid the development of a periodontal disease. Here is a list of the most important factors:

⦁ poor oral hygiene;
⦁ diseases that weaken the immune system (HIV/AIDS, leukemia);
⦁ Immune system weakened by severe stress;
⦁ diabetes, especially if it is not adequately controlled;
⦁ hormonal changes caused by pregnancy and menopause;
⦁ taking certain medications that cause side effects to the gums;
⦁ smoking.

What Contributes to the Development of Gum Disease?

Many bacteria are present in the mouth. These bacteria produce acids when they digest sugar from food debris. These acids, mixed with saliva proteins and food particles, create a biofilm (viscous film) that is deposited on teeth and surrounding structures. The biofilm is normal and not dangerous, but it must be removed as soon as possible. The best way to remove this layer is to brush your teeth after each meal.

If this biofilm is not removed quickly by proper tooth brushing, it becomes plaque. At this stage, it is still possible to dislodge the debris with proper cleaning and flossing. Note that brushing your teeth will remove much of the plaque, but about one third of the plaque is accessible only through flossing. Your dentist will no doubt tell you this, but flossing is essential for good oral health.

However, if you don’t remove plaque on a daily basis, it will mineralize and turn into tartar. Note that tartar cannot be removed by brushing or flossing your teeth; only a professional tartar remover can dislodge it.

Plaque and tartar are responsible for tooth decay and gum problems. Bacteria multiply very quickly on plaque and tartar, which are essentially food debris.

Although scaling is not normally painful, if tartar accumulations under your gums lead to infection or gingivitis, it can be a rather unpleasant experience. You may have already had painful experiences with scaling. At the Centre dentaire & d’implantologie Boucherville, have no fear: we never let our patients experience any pain whatsoever. If our team deems that the treatment may be difficult for you, analgesic solutions will be offered so that everything goes painlessly.

Gingivitis

Gingivitis is a widespread disease caused by the accumulation of plaque and tartar on the teeth, which causes inflammation of the gums.

It affects adults as well as children and teenagers. Anyone can develop gingivitis at some point in their life; however, some people may be more susceptible than others. Your dentist can tell you if you have a predisposition or if you are at risk.

The symptoms of gingivitis are very easy to detect:

⦁ the gums swell, become red and have a smooth or shiny appearance;
⦁ Gums bleed when brushing, flossing or spontaneously for no apparent reason;
⦁ the appearance of periodontal pockets (spaces between the gums and the teeth) is also possible in certain cases;
⦁ one notes a persistent bad breath (halitosis), even after brushing the teeth.

Gingivitis is the first (least severe) stage of periodontal disease. At this time, no signs of the disease are visible on a dental X-ray, indicating that the structures that support the teeth are not affected. The patient usually does not complain of pain during gingivitis, but pain may occur when the gums become inflamed.

The good news about gingivitis is that it is easily treated and prevented when improvements are made to oral hygiene. This means that gingivitis is reversible and does not get worse if treated early.

If you see signs of gingivitis, it is very important to continue to brush and floss properly, even if you have bleeding gums.

Main Types of Gingivitis

⦁ Simple or chronic gingivitis: it is the most widespread gingivitis. It is caused by plaque and tartar and can be prevented by adopting healthy oral habits. The main symptoms are swollen, red, smooth and easily bleeding gums; pain is almost always non-existent.

⦁ Ulcero-necrotic gingivitis: is often present in people whose immune system is deficient, either because of illness or severe stress. The most serious consequence of this type of gingivitis, caused by very aggressive bacteria, is the destruction of the gums, which results in the appearance of spaces between the teeth and the gums. Symptoms are similar to those of chronic gingivitis, but with the addition of acute pain and increased bleeding.

⦁ Hypertrophic (hyperplastic) gingivitis: this is mainly caused by the side effects of certain medications. It differs from the other two types of gingivitis in that the gums are more swollen and sometimes cover the teeth, making it more difficult to clean them. In the case of hyperplastic gingivitis, the texture and colour of the gums are normal, but the gums are very fibrous.

Periodontitis

Periodontitis is a gingivitis that has not been treated or that has been detected at a late stage. It thus reaches the periodontium (tissues which support the teeth). It represents the most advanced stage of the disease of the gums and it is serious, because the damage which it causes is irreversible. The most convincing result is the loss of the teeth surrounded by the periodontium affected by the disease.

The damage of periodontitis is associated with the periodontal pockets that form around the teeth where the tartar accumulated. With time, the bacteria present in these pockets destroy the periodontium, and more particularly, the periodontal ligament and the alveolar bone. By doing so, the teeth will become looser little by little, which could make them appear longer.

The teeth will then become mobile and eventually fall out if no intervention by a dental health professional is performed. The mobility of one or more teeth is what usually leads a patient to see their dentist rather than the pain that is usually not present at this stage of the disease.

Several factors can promote the appearance of periodontitis:

⦁ the quantity and the type of bacteria being in the periodontal pockets;
⦁ the presence of certain diseases which influence the effectiveness of the immune system of the patient and its capacity to fight the bacterial infection which has set up;
⦁ genetics;
⦁ smoking;
⦁ diabetes.

Evolution of Gingivitis into Periodontitis

As mentioned above, periodontitis is a gingivitis which was not treated correctly. Gingivitis usually does not cause pain and it can evolve very slowly, over several years, before reaching the stage of periodontitis.

It is thus important to remain on the lookout for the signs of gingivitis in order to treat it from the outset or to stop its evolution before it degenerates into periodontitis, because it is often too late to intercept periodontitis before irreversible damage occurs. During the terminal phase, due to bone destruction, the affected tooth is doomed to fall because it is no longer supported by a sufficient quantity of periodontium, i.e., alveolar bone, periodontal ligament and gum.

Fortunately, not all gingivitis develops into a more severe periodontal disease, but any sign of gingivitis should still be taken seriously.

Preventive Measures

Gingivitis and periodontitis can be prevented by simple means:

⦁ IMPORTANT: Contrary to what most people think, you should floss BEFORE you brush your teeth, because when flossing comes out of the interdental space, it can propel food debris and bacteria onto your teeth.

⦁ Brushing your teeth: it should be done at least twice a day, ideally after meals, but especially before going to bed at night to remove the film created by bacteria with the food deposits accumulated during the day.
Note: if you learn how to brush your teeth at a very young age, many adults forget or neglect to brush properly. Do not hesitate to ask your dentist for advice.

⦁ Flossing: When flossed properly once a day, ideally at bedtime, flossing helps to remove food debris and bacteria from between the teeth, areas that are difficult for the toothbrush to reach. To make good use of it, it is preferable to wrap it around your middle fingers; this will give you more dexterity.

⦁ Toothpaste: If you are prone to gingivitis or periodontal disease, antibacterial or anti-gingivitis toothpastes are specially designed to help you prevent these problems. Your dentist will be able to direct you to the toothpaste that best suits your teeth.

⦁ Smoking cessation: Smoking greatly increases the risk of developing periodontal disease. It is therefore in a smoker’s best interest to quit if he or she wants to keep teeth and gums healthy for a long time.

Regular visits to the dentist: An annual visit is essential and sometimes a more frequent visit may be recommended for individuals whose gums and teeth pose special challenges. During this check-up, a clinical examination is performed to evaluate the quality of the teeth and gums. X-rays are also taken to allow the dentist to obtain additional information about the teeth and surrounding structures that are not visible to the naked eye. If tartar has accumulated on the teeth, professional scaling is performed. To prevent it from coming back too quickly, advice can be given by the hygienist or dentist. It is important for pregnant women to have their mouth examined by a dental professional at least once during pregnancy, preferably during the second trimester.

When a significant amount of gum attached around one or more teeth is missing, the survival of these teeth is in jeopardy. This condition is gum recession, also called tooth decay. Gingival recession can cause, in the most severe cases, the loss of teeth if the level of attached gum is inadequate and too much of the tooth root is exposed. Gum recession can occur as a result of gum disease or orthodontic treatment. In many other cases, it can be caused by improper tooth brushing (too vigorous or using the wrong technique). With severe tooth decay, part of the root of most teeth is visible, making them appear much longer than normal and the amount of gum tissue to support them becomes insufficient. If nothing is done to improve the situation, the person with this problem risks losing the teeth that are most affected by the receding teeth.

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