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                                                        DR. DAN PETERSON

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STAGE 1 GINGIVITIS-GUM DISEASE  
EARLY GINGIVITIS

Gingivitis-This is the beginning stage when the gums are red, swollen and bleed easily.

Is a serious infection of the gums caused by plaque buildup at the gumline.  

      Gingivitis is inflammation of your gum tissue and is the beginning stage of periodontal or gum disease. Gingivitis is one of the most common untreated infections. After 35, approximately three out of four adults develop some form of gum disease. Plaque-induced gingivitis is defined as inflammation of the gingiva in the absence of clinical attachment loss*.

  Gingivitis damages your gums and reduces their ability to protect vulnerable areas.     

     Gingivitis, and its progression to periodontitis, starts with the plaque that forms mostly at the gumline at the base of the visible part of your teeth. 

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     This plaque is caused by food debris and bacteria that grow in this area. This group of harmful bacteria begins to recolonize and dominate in only 24 hours after you brush.  Their levels of toxins continue to increase causing an infection that can damage your gums and affect your immune system.  

You may not know you have this infection because it is painless

If this plaque is not removed daily it will harden to form calculus (tartar) around the necks of your teeth.

     This calculus will often result in a mechanical irritation that damages your gums. Additionally, calculus provides an area on which more bacteria easily grow, plaque and calculus will, if not removed, continue to grow and form deep pockets at the base of your teeth that will sooner or later fill with pus, infect the bone and cause tooth loss.  

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     Blood on your toothbrush or dental floss is one of the earliest and most common signs of early gingivitis. Other signs of early gingivitis are:

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irritated gum tissue                             

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swollen gums

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sore gums

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presence of plaque                                   

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gum tissue that bleeds easily upon probing which is a good indicator that you have ACTIVE disease

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5 or less bleeding (due to bacterial infection) points

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gums that are puffy and soft        

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red instead of pink gum tissue

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bad breath                                 

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pocket depths of 3mm or less with bleeding 

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gingival recession with soft tissue defects or frenum pulls

 

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Your gums should never bleed while brushing or flossing.

     If your oral hygiene habits are poor, gingivitis may progress to periodontitis.  This disease attacks your gums, bones and supporting structures of your teeth. 

     You can never completely get rid of all the bacteria in your mouth but brushing and flossing make sure the number of bacteria you do have is in a safe range. A common mistake most people make is to brush but not floss. This allows bacteria to build up to dangerous levels between your teeth where brushing alone cannot reach. When any one group or family of bacteria begin to dominate their levels of toxins increase to a point where they cause an infection.

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     The good news is that in early gingivitis:  

              Reattached gum tissue to a spotlessly clean root surface

·       No bone structure around the teeth has yet been lost.

·       It is preventable.

·       Easier to treat in a non-surgical manner.

·       Less costly to treat in its early stages.

·       And it is reversible through:

1.  Professional treatments-to remove this harmful bacterial growth from you teeth and gums. This will include one session containing dental cleaning with fluoride along with oral hygiene instruction

2.  Six month recare visit to remove the tartar, which harbors and nurtures the growth of undesirable bacteria.

3.  Good brushing for a minimum of twice a day and after meals for at least two minutes.

4.   Daily flossing. Start cleaning BETWEEN your teeth.  Periodontal disease begins between the teeth.  The area between the teeth are more prone to infection than facial or tongue gum tissue surfaces simply by anatomy.  This tissue is not keratinized like tissue found on the facial and tongue surfaces.  Non-keratinized tissue is more susceptible to breakdown.  It is also a very protected area, NOT reached by brushing or rinsing. 

     Since the disease starts between the teeth, it makes sense to start cleaning in between the teeth and than brush.  You can clean this area with interdental brushes, picks, sticks, oral irrigation, and automatic flossers.  remember this disease needs to be treated both in the office and at home.++

5.   Do not smoke or use alcoholic beverages while your gums are inflamed.

6.  Good dietary habits.  Cut back on foods and beverages that contain sugar.

Gingivitis is the only stage of gum disease that can be completely reversed to a healthy undamaged condition.  More advanced gum disease can often be controlled but damage to the teeth’s bone support cannot be reversed or rebuilt.  It is vital that gum disease be stopped and reversed in its earliest stages.  

     To insure successful results following periodontal treatments, patient cooperation in maintaining  excellent oral hygiene is essential.

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    Remember: If left untreated, early gingivitis will develop into periodontitis or severe gum disease, which will lead to:

bulletInfection that can affect your overall health
bulletSore bleeding gums
bulletDiscomfort
bulletBone loss
bulletTooth loss
bulletChanges affecting your appearance
bulletPoor nutrition
bulletPossible surgery
bulletCostly treatments
bulletSystemic complications 

  PERIODONTAL DISEASE IS USUALLY A PAINLESS PROGRESSIVE INFECTIOUS DISEASE

Mild gingivitis may be a bacterially nonspecific effect of plaque accumulation and emphasizes the need for regular plaque removal to maintain optimal gingival health.

Microbiological Changes Associated With Dental ProphylaxisJ. Max Goodson[1], Michael D. Palys[2], Elizabeth Carpino[3],
Elizabeth O. Regan[3], Michael Sweeney[3], Sigmund S. Socransky[3]JADA 2004; 135:1559-1564.

 

Case Type I Gingivitis- Diagnosis Code 4500- Inflammation of the gingiva characterized clinically by changes in color and gingival form with the presence of bleeding and/or exudates without attachment or bone loss. Light plaque and subgingival calculus can be present.


Vitamin C (ascorbic acid) is responsible for the formation and preservation of collagen in the body. "Collagen is a proteinfound in teeth, bones, tendons, blood vessels, skin, joints, and muscles. As a maintainer of collagen, vitamin C helps to heal wounds like periodontal pockets."

While the current recommended daily allowance (RDA) for vitamin C in adults over eighteen years of age is 90 mg for men and 75 mg for non pregnant, non lactating women, research suggests the body's tissue absorbs up to 200mg of vitamin C in one day - any more is excreted in the urine.

"A study at Loma Linda University in California compared using a multivitamin or a placebo and the subsequent effect on patients with Type II periodontal disease who are not currently undergoing active periodontal therapy. They were looking at quantifiable improvements in soft-tissue health - gingival index, bleeding index, periodontal pocket depth and attachment level over a period of 60 days.""At the  end of the study, there was
clinical reduction in the gingival index, bleeding index and pocket depth for the experimental group. No significant changes for attachment levels were found in the experimental or control group." Simply adding nutritional supplements to the therapy improved gingival health more than not taking the supplement.

Vitamin C is a readily available and affordable adjunct that can be used safely and effectively to treat active and maintenance periodontal patients.


Berger EK The efficacy of vitamin C in conjunction with periodontal therapy  Contemporary Oral Hygiene 2004;4(4):31

Several populations warrant special attention with respect to vitamin C requirements.  These include patients with periodontal disease, smokers, pregnant and lactating women, and the elderly.

[Bsoul SA, Terezhalmy GT.  Vitamin C in Health and Disease.  JContemp Dent Pract 2004 May;(5)2:001-013.]

 

*AAP Parameters of Care

February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
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PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
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