What is gingiva (gum) and its function?

The gingiva (gum) is the protective type of skin that is closely adapted to the necks of the teeth and covers the bone holding the roots of the teeth. There is a shallow ditch like space that separates the margin of the normal gingiva from the tooth surface. This space is 2mm in depth and is called gingival sulcus. It is one of the places that a dentist will carefully examine to detect the presence of gum disease.

Is the colour of gingiva (gum) same in all individuals?

The colour of the gingiva is usually coral pink, but it can vary according to the complexion of the in individual. In general, darker persons have darker gingiva; but in some individuals there can be excess of pigments that give the gingiva a brownish tinge.

How is the tooth held in the jaws?

Each tooth consists of two parts (a) the crown - that can be seen in the mouth of the person and (b) the root that is enclosed within the bone and the gingiva. The tooth is not directly attached to the bone, for there is a thin, elastic and fibrous tissue between them called the periodontal ligament, which attaches the tooth to the surrounding bone. When the tooth is used for biting or chewing, the periodontal ligament acts like a cushion and prevents the biting or chewing force to be directly transferred to the jaw bone. The gingiva, periodontal ligament and the bone that encloses the roots of the teeth are collectively referred to as periodontal tissue.

Who is a Periodontist?

A Periodontist is a specialist trained in the care of (periodontal tissues) gums and other tissues that support the teeth. Periodontists have years of extra schooling and experience that allow them to use special techniques to treat advanced periodontal

Is it true that a normal tooth shakes slightly?

Yes it does. Between the roots of the teeth and its surrounding bone there is a thin, fibrous and elastic tissue called the periodontal ligament. Because of this if one holds the tooth with two fingers and tries to shake it gently, the tooth will be felt to move a fraction of a millimeter. In the presence of gum disease this movement increases as a result of a reduction of tooth supporting tissues around the roots.

Is it true that bacteria's are present in healthy mouths?

The mouth of an unborn child is free of bacteria, but during its birth it becomes colonized by bacteria from the mother's birth canal. Shortly afterwards other species of bacteria are acquired from the infant's environment. The bacteria in the infant's mouth share all the food that the infant takes and multiply and become permanent residents of the mouth. When the child becomes older and teeth erupt, the sulcus is also formed around the erupted teeth. The sulcus becomes the new hiding place for some species of bacteria while others prefer the hard surface of the teeth to colonize. The bacteria are not harmful and the individual's teeth and periodontal tissues are free of any disease as long as the teeth and their surroundings are kept reasonably clean by regular tooth brushing.

What is plaque and how does it form?

In a mouth that is not kept clean by regular oral hygiene practice, a thin, soft, sticky colorless layer is constantly formed on the surface of teeth and it is called dental plaque. Dental plaque is just layers of growing mass of various types of bacteria that are present in the mouth. Dental plaque in small quantities is almost invisible, but in large quantities it can be felt with a tongue as a fuzzy unclean coating. If plaque is not completely removed everyday by tooth brushing and flossing, the remaining plaque becomes a stony crust called calculus/tartar. Calculus clings to the teeth with such force that only a dentist or a hygienist with the help of special instruments can remove it.

What causes Gum Disease?

Gum disease, is an infection of the gums caused by bacteria. These bacteria produce toxins that irritate the gingiva, and also directly infiltrate into the gingiva causing them to become inflamed and bleed easily. If the irritation persists, the gingiva separate from the teeth and form pockets. Plaque then forms within these pockets and eventually destroys the gingiva and the underlying bone. The teeth may then become loose and fall out or need to be removed. There are other factors that may contribute to gum diseases. They are as follows ·

Plaque traps-Decayed teeth, broken or ill fitting dentures, crowded or crooked teeth, improper filled teeth may provide secure areas for plaque to form, from where it cannot be removed by routine oral hygiene methods. ·

Systemic factors-Individuals with diseases such as Diabetes, leukemia or people who are on certain medications may be particularly prone to gum diseases, because their resistance to this disease has been lowered and/or that their gums become increasingly sensitive to any local irritation.

What are periodontal pockets?

As mentioned earlier there is a shallow ditch like space that separates the margin of the normal gums from the tooth surface. The depth of this space ranges from 0-2mm and is called gingival sulcus. As gum disease progresses the gum margin becomes detached from the tooth surface and the sulcus becomes progressively deeper. This sulcus that has been deepened by disease is called periodontal pocket. It is one of the places that a dentist will carefully examine to detect the presence of gum disease. In the early stages there are usually no symptoms and patients are unaware of the progressing disease, but as the inflammation spreads there is bleeding from the pockets

Does professional cleaning or removal of tartar cause loosening of teeth?

Teeth are held firmly by the gingiva and the supporting bone of the periodontium. Bad oral hygiene results in the formation of plaque. If plaque is not removed in time it calcifies to form a hard mass called tartar/calculus. Professional cleaning removes this tartar and arrest further destruction of supporting bone. However, tartar deposit often hold together teeth that have already been weakened by chronic gum disease and mask existing tooth mobility. Therefore removal of the tartar deposit at this stage may give a false feeling of teeth becoming loose. Nevertheless removal of tartar deposit is only the first step towards periodontal health.

What are the common signs of gum diseases?

Common signs are bleeding, red and swollen gums. Irrespective of the person's complexion, the gums should never be red, or be swollen. Persistent bad breath, receding gums, increasing spaces between the teeth, one or more teeth becoming loose, and vague aching, itching or discomfort around the gums are some of the other common signs.

Is gum disease the only cause of bad breath (halitosis)?

Gum diseases are the main source of bad breath; other causes include diseases of the sinuses, lungs, stomach and throat infection.

Is it true that some medications cause swollen gums as side effects?

Yes, some drugs like Dilantin sodium taken for treatment of Epilepsy result in swollen gums. These conditions often require surgical excision of the swelling constant maintenance treatment

Do all people require professional cleaning of teeth?

As keeping the mouth clean is not an easy job almost everybody need professional cleaning. But this kind of cleaning is essential particularly for those who are unable to prevent tarter accumulation on their teeth.

Can mouthwashes prevent gum disease?

Mouthwash reduces the amount of bacteria present in the mouth and provides an opportunity for the gum to heal. However mouthwashes can be harmful if used for prolonged time without professional monitoring.

Is it necessary to massage the gums after tooth brushing?

It is a good habit to massage the gums after brushing, for it improves the blood circulation to the area and helps it to maintain health.

Does pregnancy cause gum disease?

During pregnancy some change in hormonal level in the body does occur. This causes the gum to be hypersensitive and therefore over react to any local irritation. Even in the presence of small quantities of plaque the gums get inflamed. Some times big localized swelling may form. A few weeks after the birth of the child when the mother's hormonal level comes to normal the periodontal condition usually returns to the situation that existed before the pregnancy.

Do children develop gum diseases?

Yes, but it is not common. However children with very poor oral hygiene do get gum disease.

Can vitamin deficiency cause gum diseases?

Yes, Vit C deficiency is known to cause a condition known as Scurvy.

Does habits like pan, beetle nut chewing, smoking affect the gingiva?
Yes, the ingredients present like lime, tobacco and other byproducts can stain the teeth, help plaque accumulation and irritate the gums. Some ingredients in pan has been shown to cause cancer in the mouth.

What effect does diabetes have on the gums?

Uncontrolled diabetes can make the gum more prone to periodontal disease. Diabetes patients also suffer from delayed healing of the gum tissue.

Hard toothbrush or vigorous brushing, are they harmful to the gums?

Hard tooth brush or/and excessive brushing force frequently causes the gums to recede, leading to exposure of root surface and sensitiveness of the teeth.

Do all gum disease require surgical procedure?

Several non-surgical techniques are available for treating periodontal conditions, and the technique chosen will depend on the extent of damage that the disease has caused to the periodontium. The Periodontist will evaluate the condition of the periodontium and removal all the plaque and tartar deposits. In addition to this he will also use various antiseptics and antibiotics that are specifically meant for treating periodontal disease. If this treatment also fails to completely resolve the disease, he will have to resort to periodontal surgery.

What is a graft and can it replace tissues lost due periodontal disease?

If the gum disease is diagnosed at a stage when there is not much loss of periodontal tissues, the lost tissues can be grafted. Grafts can be of soft tissues or hard tissues. The former is always taken from another site in the mouth of the patient being treated. Hard tissue grafts can purchased from tissue banks.

Can gum/periodontal problems recur after surgical treatment?

Treatment of gum disease whether by surgical or non-surgical means only takes care of the existing problem. If proper maintenance therapy is not given by the dentist or if patient does maintain good oral hygiene the gum disease will certainly recur.

Can gum disease lead to teeth problem?

Sometimes prolonged infection of the gums spreads to the tooth through the root apex into the pulp tissue of the tooth leading to death of the tooth itself. Such tooth requires both root canal and periodontal treatment. Why does the tooth look longer after surgical gum treatment? Gum disease left untreated for a long time leads to loss of supporting bone around the roots of the teeth. The lost bone is replaced by unhealthy soft granulation tissue, which although it does not reduce the mobility of the teeth keeps the gum margin at almost the normal level. During surgical gum treatment the unhealthy granulation tissue is removed that results in the collapse of the gum tissues into the spaces left behind by the granulation tissues. As a result the gums recede and make the teeth appear longer

How to keep the gums healthy?

By keeping good oral hygiene, having regular dental check-ups and a good balanced diet

Should we avoid brushing and flossing when the gums bleed?

Bleeding gums indicated presence of gum disease. As poor oral hygiene is the primary cause of gum disease one should realise that it is improper brushing technique and flossing was the cause of the problem. Correct brushing and flossing technique should be adopted, which should be supplemented by mouth wash.

Is there any advantage of mechanical brush over regular brush?

No, but they are helpful for physically handicapped patients