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Tuesday, March 6, 2012

Gum Recession



INTRODUCTION :  
Gum/ Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them. Healthy gingiva are usually coral pink, but may contain physiologic pigmentation. Changes in color, particularly increased redness, together with edema and an increased tendency to bleed, suggest an inflammation that is possibly due to the accumulation of bacterial plaque.
                                           Receding gums can be caused by a number of reasons. But one of the biggest problems is that it is actually quite a difficult condition to spot. If the gums are receding very slowly, it is always difficult to identify very gradual erosion. By then, it could be too late to take the necessary steps to slow it down.
                                         

Gum recession is most common in people over the age of 40. However, you could probably amend that to say that it is identified most often when people are in their Forties. In many cases, the gums have begun to recede very slowly before that so there was probably several opportunities for them to be diagnosed and for treatment to start.


So what causes your gums to recede?
                     In the first instance, it can be something as simply as brushing your teeth too hard. We all want to get our teeth as clean as possible, but it is important that you clean your teeth in the right way. Your dentist can explain the right approach to oral hygiene and demonstrate brushing techniques that can ensure that your gums are not damaged. They will also be able to recommend an appropriate toothbrush.

                                  A more serious cause of receding gums is gum disease. If plaque and bacteria are allowed to build up on your teeth, then the bacteria can attack the gums and become embedded into gaps between the gums and the roots of the teeth. Advanced gum disease will need to be treated by a dentist. In the majority of cases, it involves a deep clean of your teeth which includes clearing out the hardened plaque from between the gums and around the roots of the teeth. It requires a local anaesthetic as it can be painful.
                               
Gum Recession
                                                             Gum Recession


 Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.




Gingivitis is inflammation of the gums (gingivae).

Causes, incidence, and risk factors

Gingivitis is a form of periodontal disease. Periodontal disease involves inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets (alveolar bone).
Gingivitis is due to the long-term effects of plaque deposits. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed parts of the teeth. It is a major cause of tooth decay. If you do not remove plaque, it turns into a hard deposit called tartar that becomes trapped at the base of the tooth. Plaque and tartar irritate and inflame the gums. Bacteria and the toxins they produce cause the gums to become infected, swollen, and tender.
Injury to the gums from any cause, including overly vigorous brushing or flossing of the teeth, can cause gingivitis.
The following raise your risk for developing gingivitis:
  • General illness
  • Poor dental hygiene
  • Pregnancy (hormonal changes increase the sensitivity of the gums)
  • Uncontrolled diabetes
Misaligned teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (such as braces, dentures, bridges, and crowns) can irritate the gums and increase the risk of gingivitis.
Medications such as phenytoin and birth control pills, and heavy metals such as lead and bismuth are also associated with gingivitis.
Many people have gingivitis to a varying degree. It usually develops during puberty or early adulthood due to hormonal changes and may persist or recur frequently, depending on the health of your teeth and gums.

Symptoms

 

  • Bleeding gums (blood on toothbrush even with gentle brushing of the teeth)
  • Bright red or red-purple appearance to gums
  • Gums that are tender when touched, but otherwise painless
  • Mouth sores
  • Swollen gums
  • Shiny appearance to gums

Signs and tests

The dentist will examine your mouth and teeth and look for soft, swollen, red-purple gums. Deposits of plaque and tartar may be seen at the base of the teeth. The gums are usually painless or mildly tender.
No further testing is usually necessary, although dental x-rays and dental bone measurements may be done to determine whether the inflammation has spread to the supporting structures of the teeth.
See: Periodontitis

Treatment

The goal is to reduce inflammation. The teeth are cleaned thoroughly by the dentist or dental hygienist. This may involve various instruments or devices to loosen and remove deposits from the teeth.
Careful oral hygiene is necessary after professional tooth cleaning. The dentist or hygienist will show you how to brush and floss. Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases. Antibacterial mouth rinses or other aids may be recommended in addition to frequent, careful, tooth brushing and flossing.
Repair of misaligned teeth or replacement of dental and orthodontic appliances may be recommended. Any other related illnesses or conditions should be treated.

Expectations (prognosis)

The removal of plaque from inflamed gums may be uncomfortable. Bleeding and tenderness of the gums should lessen within 1 or 2 weeks after professional cleaning and careful oral hygiene. Warm salt water or antibacterial rinses can reduce the puffiness. Over-the-counter anti-inflammatory medications will ease any discomfort from a rigorous cleaning.
Healthy gums are pink and firm in appearance. Strict oral hygiene must be maintained for your whole life or gingivitis will recur.

Complications

  • Recurrence of gingivitis
  • Periodontitis
  • Infection or abscess of the gingiva or the jaw bones
  • Trench mouth


Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
Diagram comparing healthy and diseased gumsThere are many forms of periodontitis. The most common ones include the following.
  • Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
  • Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
  • Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression. 



                                                    Periodontitis
               
Gum recession between the teeth and redness indicate periodontitis.



Causes, incidence, and risk factors

Periodontitis occurs when inflammation or infection of the gums (gingivitis) is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.
Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Symptoms

  • Breath odor
  • Gums that appear bright red or red-purple
  • Gums that appear shiny
  • Gums that bleed easily (blood on toothbrush even with gentle brushing of the teeth)
  • Gums that are tender when touched but are painless otherwise
  • Loose teeth
  • Swollen gums
Note: Early symptoms resemble gingivitis.

Signs and tests

Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gums. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be receded.
Dental x-rays reveal the loss of supporting bone and may also show the presence of plaque deposits under the gums.

Treatment

The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Rough surfaces of teeth or dental appliances should be repaired. General illness or other conditions should be treated.
It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling). Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. It is often recommended that patients with periodontitis have professional tooth cleaning more frequently than twice a year.
Surgery may be necessary. Deep pockets in the gums may need to be opened and cleaned. Loose teeth may need to be supported. Your dentist may need to remove a tooth or teeth so that the problem doesn't get worse and spread to nearby teeth.

Expectations (prognosis)

Some people find the removal of dental plaque from inflamed gums to be uncomfortable. Bleeding and tenderness of the gums should go away within 1 or 2 weeks of treatment. (Healthy gums are pink and firm in appearance.)
You need to follow careful oral hygiene for your entire life or the disorder may return.

Complications

  • Infection or abscess of the soft tissue (facial cellulitis)
  • Infection of the jaw bones (osteomyelitis)
  • Return of periodontitis
  • Tooth abscess
  • Tooth loss
  • Tooth flaring or shifting
  • Trench mouth


The third most common reason for gum recession is orthodontic treatment. When teeth are moved into a better position through an orthodontic treatment, it can often result in the roots of the teeth becoming more prominent. So as the tops of the teeth move to become straighter and to refine the bite and smile, the roots of the teeth can be pushed in the other direction and appear more visible above the gum line.
In cases of serious gum recession, either caused by gum disease or by orthodontic treatment, the only solution may be surgery. Gingival grafting is a treatment that involves grafts from either neighbouring gums or the roof of the mouth onto the affects areas. The surgical procedure is usually performed by a specialist periodontist rather than a dentist and the patient will require a local anaesthetic. Your new gums will usually be healed within the space of about a month. In some cases, once the gums have healed the periodontist may be required to perform some additional shaping to ensure that the gum grafts look as natural as possible.

If you are concerned about your gums receding, there are a number of symptoms that you can watch out for. Of course, you should keep an eye on your gums, but it can be difficult to tell whether they are receding or not unless you have a professional eye. However, if you find that your teeth are becoming more sensitive, this can be an indication that more of your tooth is becoming exposed as the gums recede.

You may also notice a change in the colour of some of your teeth. As the gums recede, the lower part of the tooth which becomes exposed may be whiter than the original crown of the tooth.
It is important that you take responsibility for the health of your own teeth. However, one of the most important things you can do is regularly visit your dentist. As a professional, you dentist will be able to spot whether plaque is building up on your teeth and causing gum disease. They will also be able to identify whether you have cavities below the gum line, which is another indication that gum disease is causing your gums to recede.
Regular visits to your dentist should mean that problems are spotted early and dealt with accordingly. If this happens, then you should be able to maintain healthy gums and healthy teeth for a long time beyond your Forties.



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