Gingivitis Treatment in Hyannis, MA

In the broad sense, the periodontal diseases are considered as a group of related, but vastly different, inflammatory diseases affecting the periodontium, that is the supporting structures that surround the teeth, and comprise two main categories: gingivitis and periodontitis. Gingivitis is plaque-induced and a reversible condition; while periodontitis is an irreversible condition which can lead to tooth loss. Both are inflammatory conditions that are considered to be infectious. The role of dental bacterial plaque in the development of both of these diseases has long been known. Sufficient evidence proposes that susceptibility to periodontal disease varies among individuals, which may possibly be due to genetic factors, host resistance (i.e., immune function), and adequate nutrition.

Diagnosis of Gingivitis
Clinical signs and symptoms of gingivitis are redness, swelling, bleeding on gentle probing, and spontaneous bleeding and/or visible pus in the absence of any bone loss, periodontal pocketing, or apical tissue migration along the tooth root. Clinical signs of gingivitis can usually be seen after 10-20 days of plaque accumulation. These signs of inflammation are usually precursors to attachment loss around the teeth, which would then be referred to as periodontal disease (periodontitis). Gingival recession is considered periodontitis due to the loss of attachment around the teeth.

Gingivitis is the infection of the gums. If allowed to progress, gingivitis can turn into periodontitis, the invasion of the underlying bone that anchors the teeth in place. As that happens, the gums may recede, exposing the root surfaces and increasing sensitivity to heat and cold. Teeth may even loosen because of bone destruction.

Diagnostic Tests

Clinically, gingivitis assessment in regards to plaque accumulation involves several factors. These include visualization of gingival tissue changes in terms of color, contour and bleeding tendencies. Also, the use of a periodontal probe by the dental health care provider can help to diagnose gingival inflammation and bleeding. Bleeding upon probing is a clear sign of gingivitis.

Progression from Gingivitis to Periodontitis

Gingivitis may resolve itself or lay quiet for an indeterminate period; however, the potential for the formation of a periodontal pocket (periodontitis) exists at any time. When pockets are detected clinically, they usually are associated with calcified plaque deposits, called calculus, present on the tooth root surfaces. The progression from gingivitis to periodontitis requires varying amounts of time in different individuals, and may not happen at all in others.

Studies have suggested that under typical circumstances more than six months may be required for gingivitis to advance to periodontitis. In both diseases, the host mounts an inflammatory response in the approximating gingival tissue to bacterial accumulations on the teeth. This host response prevents bacterial growth into the tissue, and removes bacterial products such as antigens, lipopolysaccharides (LPS), and enzymes that have penetrated the tissue. However, the inflammatory response can also activate enzymes known as matrix metalloproteases, which are the agents responsible for collagen loss in the tissues. These latent collagenolytic enzymes can be converted to their active forms by proteases and reactive oxygen species in the inflammatory environment, thus giving rise to elevated levels of interstitial collagenase in the inflamed gingival tissue. The resulting attachment loss deepens the gingival sulcus, thereby creating the periodontal pocket. By definition, this loss of attachment converts gingivitis to periodontitis.

A very important message is: “Gingivitis precedes periodontitis, and this implies that the prevention of gingivitis is a key preventive measure for periodontitis.” Prevention is the cornerstone to both good oral and systemic health.