When you think about which diseases are the most common globally, you probably think of diabetes, obesity and cardiovascular disease. But in terms of the number of people affected worldwide, there’s one disease that tops all of those—periodontal disease, which includes gingivitis. While cardiovascular disease affects about 8% of the global population…diabetes, nearly 11%…and obesity, 16%, periodontal disease impacts between 20% and 50% of the global population.
And while it is true that those other diseases are more directly deadly than periodontal disease, gingivitis contributes to risk for heart disease, diabetes, Alzheimer’s and other life-threatening illnesses, even some cancers. Given that the systemic impact of periodontal disease goes far beyond the mouth, fixing the oral-health crisis in the US could save billions of dollars annually in health-care costs.
Bottom Line Personal asked Kami Hoss, DDS, a member of the board of counselors at UCLA School of Dentistry, what you should know about gingivitis and how to protect yourself…
Before breakfast…
After breakfast…
Before bed…
Periodontal disease is the umbrella term for disease of the gums and bones of the mouth. The first stage of periodontal disease is gingivitis, a word derived from the Latin gingivae, for gums, with the suffix itis, referring to inflammation. So, gingivitis is general inflammation of the gums which, left untreated, progresses to the later stage of periodontal disease, called periodontitis.
A patient with gingivitis has red, swollen gums. Other gingivitis symptoms include bad breath and gums that bleed easily. In fact, bleeding often is the first indicator of disease. If you regularly spit out blood when you’re flossing or brushing your teeth, there is a problem. Never ignore this symptom.
A bacterial infection causes gingivitis. The mouth is home to billions of microbes belonging to some 700 to 1,200 species, including many bacteria. Some of those microbes are beneficial, while others are harmful. When your oral hygiene is poor, a microbial imbalance occurs in which harmful microbes flourish in the mouth, colonizing the gums. The microbes produce toxins and enzymes that break down the surrounding gum tissues. Your body sends immune cells to the gingival tissues to fight off the microbes, but this response is inflammatory and contributes to the swelling, redness and bleeding that are hallmarks of gingivitis.
Risk factors for gingivitis include age, smoking, stress and a poor diet, especially one high in sugars and simple carbs and low in vitamins D, K-2, and C. Genetics and hormonal changes also may play a role, but 90% to 95% of gingivitis cases can be prevented.
When you ignore gingivitis, the microbes from the mouth can travel to other parts of the body, causing inflammation and infection. And in the mouth, the gums will deteriorate and recede as gingivitis worsens into periodontitis. The teeth have natural shock absorbers where they connect to the bone. These tissues, called periodontal ligaments, will be destroyed along with the rest of the gum tissue that surrounds the teeth. Spaces appear between the teeth…teeth begin to fall out…and eventually even the bone beneath the gums starts to deteriorate. The loss of these structures is permanent.
Not only is gingivitis treatable, it is reversible…and most gingivitis treatment can be done by you at home.
The first step is to visit a dentist and get a thorough professional cleaning so that you’re starting with a clean mouth. After that, you need to start taking proper care of your oral health, which means developing a smart daily routine and sticking to it, along with regular dental visits for cleaning and to stay on top of any problems. By faithfully tending to your oral health, you can expect to be gingivitis-free in a relatively short amount of time. In the early stages of gingivitis, you might see improvement in just a few days…in moderate cases, it might take several weeks…and in advanced cases it could take a few months. There is no “gingivitis medication,” although if you’re suffering from an acute infection, a dentist may prescribe an antibiotic for short-term use.
If your gingivitis has advanced to periodontitis, treatment is much more involved. You will need your dentist to help with treatment and possibly an oral surgeon and periodontist. Treatments can include costly medications, gum surgeries, laser treatments, bone surgeries and augmentations to build up the level of bone.
Imagine your mouth as a lush garden of microbes, where the good microbes (picture them as flowers, shrubs and ornamental plants) outweigh the bad (the weeds). The goal is to encourage the growth of the good microbes and root out and eliminate the bad ones. How to do that…
Avoid acidic toothpastes and mouthwashes, alcohol-based products, artificial colors and flavors, and flosses with petroleum or plastic-based waxes.
Seek out toothpastes, mouthwashes and flosses containing nanohydroxyapatite, a nontoxic synthetic version of the mineral hydroxyapatite, which remineralizes enamel, whitens teeth, reduces sensitivity and prevents plaque formation.
To foster growth of healthy microbes while discouraging unhealthy ones, look for products containing the prebiotics inulin, erythritol, and xylitol.
In addition to a soft-bristled toothbrush, toothpaste and floss, purchase a tongue cleaner to help remove harmful bacteria that hide in the deep crevices of the tongue.
Use the mnemonic “BB, BB,” which stands for “before breakfast, before bed,” to remember the optimal home-care routine
Yes, you should brush before, not after breakfast, because the acids from your food remain active in your mouth for 30 to 60 minutes after eating, and you don’t want to rub them into your teeth.
In the morning, rinse with an alkaline mouthwash to raise the pH level of your mouth and loosen plaque. Next, floss your teeth and clean your tongue using your tongue tool. Brush last, then eat breakfast. After breakfast, freshen your mouth with mouthwash or a spray.
Before bed, repeat the same routine, but do the mouthwash-rinse last rather than first. You don’t need to floss or tongue-scrape more than once per day, although doing it twice is not harmful.
