Gingivitis, a periodontal disease, or pyorrhea is an infection caused by the accumulation of plaque. This infection affects the tissues that are around the teeth. There are four distinct tissues around the tooth supporting them. These are the gum or gingival, the outer layer of the tooth root, the cementum, alveolar bone or ridge, the bony sockets in which tooth is fixed, and the periodontal ligament that runs from cementum to alveolar bone. This ligament is the one that anchors the tooth stably against the various forces of mastication. The specific group of bacteria causing the infection is still not known. The latest research has identified 3 species of gram-negative anaerobic bacteria that are normally present in the mouth; they are: Actinobacillus actinomycetemcomitans, Eikenella corrodens, and Tannerella forsythia. As per a recent report by the CDC (Center for Disease Control and Prevention), the incidence of gingivitis among people aged 30 years and above is 47.2% and people aged 65 years and above is a shocking 70.1%. Males are more prone to this condition than females. Additionally, people who are living below the poverty line are more prone to this. The CDC, along with the American Academy of Periodontology (AAP) and the American Dental Association (ADA), is working to improve surveillance of the disease. The initial symptoms are gums bleeds, inflammation, swelling, and tenderness. There could also be a foul smell in the mouth. There are various factors that make one prone to gingivitis, like genetics, poor oral hygiene, chewing tobacco, smoking, pregnancy, certain medications like steroids, chemotherapy, certain calcium channel blockers, anti-epilepsy drugs, and oral contraceptives. At this stage, the infection is still reversible and a visit to the dentist along with medicines and oral hygiene can help significantly. Since the pain can be sudden, it is important to have bi-annual dental checkups. In mild cases, nonsurgical treatment options can be used. The procedure starts with scaling below the gum line. An instrument called Root Surface Instrumentation (RSI) is used. A specialized curette is used to mechanically remove the calculus and plaque. This may call for multiple visits to the dentist, depending on the amount of plaque. Also, local anesthesia could be used for a painless experience. Other supplementary treatments like bite adjustment, removal of plaque retaining restorations, etc, could be implemented. Root planning, another procedure, cleans the root surfaces of plaque, calculus and softened dentine, leaving a glassy and smooth surface. Any deep pockets are also cleaned.
This should be done routinely and should be followed by systemic antibiotic treatment. AAP has also found from various studies that antibiotics by tray delivery have no benefits. Other options include gum grafting, regenerative procedures, laser procedures, dental implants, dental crown lengthening, plastic surgery, and pocket reduction procedures. After a successful completion of the procedure, proper maintenance is essential. This consists of regular checkups and thorough clean up by a dental professional to prevent reintroduction of an infection. This helps monitor the affected teeth. It is best to brush your teeth twice a day for two minutes with a fluoride toothpaste and floss regularly to prevent any other issues.