TOOTH PASTE AND GUM DISEASE

80 % of adults possess some sort of gum disease.
Gum disease may range from mild, simple gum inflammation to some more serious form where tissue is damaged and teeth are lost.Brushing twice daily, flossing daily, eating a well-balanced diet, and visiting your dentist regularly can all help prevent gum disease.
GINGIVITIS
Gingivitis starts with the bacteria within the mouth.The condition usually develops due to "an increase in bacteria quantity and a change in balance of bacterial types from harmless to disease-causing bacteria." It is when the harmful bacteria are allowed to build up on teeth, forming plaque, that gingivitis can set in. If the plaque is not removed, it forms a hard layer on the tooth called tartar. The gums may become tender, red, swollen and bleed easily.

Periodontitis
Periodontitis can happen when gingivitis isn't treated. With time, gums pull away from the teeth and plaque can grow below the gum line. This can destroy the tissues and bone that support the teeth. Periodontitis has four common types. Aggressive periodontitis is a severe inflammation with rapid bone and tissue loss. Eventually tooth loss occurs, typically within a year's time. Chronic periodontitis also shows in inflammation with tissue and bone loss. The loss usually occurs slowly and is characterized by receding gums. Disease-related periodontitis occurs with systemic diseases such as diabetes, AIDS and heart disease. Necrotizing periodontitis is an acute infection of the gums and its symptoms include spontaneous bleeding, rapid onset of pain and a bad odor.

Toothpaste
Toothpastes are advertised as anti-microbial, tartar control, tooth whitening, sensitive, baking soda, abrasive, gels, fluoride or gum care.The common toothpaste is approximately 75 % humectants and water, 20 % abrasive (silica or powdered calcium), and 1-2 % foaming and flavoring agents, buffers, coloring agents, opacifiers and fluoride.Toothpaste should protect from cavities, softened enamel and plaque.Dentists are skeptical regarding tartar control and whitening toothpastes. Tartar only accumulates when a buildup of plaque has been left on the teeth for over 24 hours and whitening toothpastes do not do anything for oral health.

Prevention
The key to any gum disease is prevention. Brushing, flossing and mouth washing, and visiting your dentist will help to avoid gum disease. Most experts agree that toothpaste with fluoride is effective when used often and correctly."Fluoride treatment in children has helped to account for the decline in periodontal disease in adults." Fluoride helps to strengthen tooth enamel and fight tooth decay, making them less vulnerable to bacteria.

Considerations
Gum disease is treated by surgery, bone and tissue grafts, prescription-grade mouthwash, scaling and root planning, or antibiotics. Once the mouth has succumbed to gum disease, toothpaste alone does not treat the problem. Treatment is aimed at stopping and controlling the progression of the disease, and restoring any damage if possible. Home maintenance is important to the success of treatment.

Gingivitis: Cause and Management

Gingivitis can be a kind of periodontal disease that involves redness and infection of the gums. This soreness and infection result in break down of tissues of which keep the teeth along with the gums, the ligaments additionally, the tooth sockets.

Leads to: Gingivitis will not form immediately. It is among the most long-term negative effects of plaque remains as a result of incorrect brushing and flossing. Plaque is usually a awkward material made of bacteria, mucus, and food debris of which evolves on revealed portions of the teeth. It is really a major explanation for oral cavaties as plaque, when not eradicated, gets a tough deposit termed tartar. Tartar next gets cornered on the base of the tooth. Plaque as well as tartar are designed for irritating the gums as well as turning it into inflamed. Bacteria additionally, the poisons that they produce increase the risk for gums to turn into infected, swollen and tender. Tender gums simply bleed.

Moreover, difficulties for the gums as a result of extremely strenuous brushing or flossing of the teeth may possibly lead to gingivitis. Medications as well as birth control pills and heavy metals which include cause and bismuth also can give rise to the development of gingivitis. Misaligned teeth, rough edges of fillings, and ill-fitting or maybe not clean mouth device which include braces, dentures, bridges, and crowns can bother the gums and also improve the probability of gingivitis. Along with such, common illness, terrible dental hygiene, pregnancy and unrestrained diabetes increase your probability of developing gingivitis.

Gingivitis occurs for a numerous degree on people coming from all of all ages. It usually evolves while in puberty or maybe first adulthood as a result of hormonal changes and may even happen again often with regards to the health and fitness of the teeth and gums.
 Symptoms could be bleeding gums, gums that will be tender whenever handled, bright red or maybe red-purple appearance of gums, mouth sores, shiny appearance of gums and swollen gums.

Treatment: If you actually plan a check-up together with the dentist, he will probably study the mouth and teeth and investigate soft, swollen, red-purple gums. The gums are frequently painless or maybe slightly tender. Once signs and symptoms of gingivitis are normally found, quite often, you can be that has a painful operative gingivitis treatment.

However, teeth’s health complications may be absolutely definitely avoided with very good oral tactics. Oral health authorities strongly recommend good care of the oral and dental regions with the aid of high-quality and helpful mouth care products which include toothpaste and mouthwash. As the cliche goes, “elimination provides multiple advances over cure” as it could really be difficult to treat gingivitis as soon as there is absorbed the dental regions.

Gingivitis and gum diseases may be averted from developing on the onset. Regular daily brushing with the aid of botanical toothpaste and concluding it that has a botanical mouthwash is usually a more beneficial solution for gingivitis.

Why Do My Gums Hurt When I Do Work Out?

Why Do My Gums Hurt When I Work Out?  

In case your gums hurt when you workout, possibly you have a cavity or you may be experiencing some degree of gum disease. Regular dental visits, proper dental hygiene and a healthy diet can prevent most causes of gum pain. Schedule an appointment with your dentist to correctly diagnose the main cause of your sore gums.

Cause 
Gum disease and cavities are caused by plaque building up on the teeth. Plaque is a sticky material consisting of bacteria, mucus and food that can harden into tartar if it remains on your teeth for a long-period of time. Gingivitis occurs when bacteria and toxins begin irritating and inflaming the gums. Periodontitis is a more advanced form of gum disease, which is caused by the build-up of plaque and tartar causing the teeth to pull away from the gums. Cavities are caused by tooth decay, which occurs when plaque removes the outer layers of your teeth allowing bacteria and acids to reach nerves and blood vessels.

Identification
Gingivitis can cause tenderness inside the gums during working out due to possible mouth sores and inflammation in the gums. You may even experience bleeding and redness of the gums while brushing your teeth or flossing. In advanced cases of periodontitis, the farther the gums are pulled from the teeth, the more destructive the result will be to the bone and ligaments. The teeth may become loose and need to be removed. A cavity may have a visible hole that causes a toothache and sensitivity to the teeth that may be felt in the gum line. If you do exercises in which your feet forcefully hit the ground, your bottom and top teeth may click and cause a shooting pain in your teeth and gums.

Treatment
Early gum disease can be reversed by taking certain measures. Dentists recommend having your teeth professionally cleaned twice per year; however, in severe cases of gum disease, you may need professional cleanings more frequently. You may also need crooked teeth straightened. If you have dental or orthodontic appliances, such as braces or a mouth guard, replacements may be necessary if they're not fitting properly or being cleaned appropriately. A filling is used for most cavities; however, crowns, root canals, or tooth extractions may be necessary in more severe cases of tooth decay.

Prevention
Make use of a soft-bristled toothbrush that's in good condition and brush your teeth with an fluoridated toothpaste at least twice per day. Fluoride can reverse early signs of decay.Floss gently at least once per day. If you're prone to gingivitis, brush after every meal and before bedtime. If you wear a mouth guard while exercising, clean it regularly. To prevent cavities, follow the same previously mentioned steps and also rinse with fluoride, avoid sticky foods .

Building an healthy dental life

At times folks, particularly adults often get too occupied that they forget to take good care of their dental health. This isn’t that bad if you miss out brushing or flossing a few times but repeatedly over a course of a long time, this will get you into trouble. What’s dangerous about not taking care of your dental health is that this could get you gum disease - a condition wherein the gums swell, weaken or discolor due to bacterial infection. Most of the time, you won’t notice the symptoms during the initial stages but overtime, this will progress into something much serious.

The initial symptoms may include swelling of the gums, discoloration of the gums, a painful sensation which is more evident when drinking hot or cold drinks and chronic bad breath. The first stage of gum disease is called gingivitis and is when the symptoms are light and has a great chance to get by unnoticed. If you’re lucky, the condition will heal itself but if not, you may be finding yourself with the same symptoms, only more severe.

Therefore, it is important to cure gingivitis and build a healthy dental care routine and here are a few suggestions for you. First is to do the basics: brush your teeth three times a day with a soft toothbrush and do it with a smooth, circular motion. Brushing to harshly will only worsen the condition but doing so lightly should help maintain clean teeth and gums. Also make sure to floss to get rid of food debris after meals - this ensures that your gums will be free of bacterial infection for the next few hours.

One of the best ways to keep a healthy dental life and also another good gingivitis cure is to maintain a steady and healthy source of vitamin C. Since it plays a major factor in our immune system, having vitamin C will also help fight off bacterial infections and speed up the healing process of our gums so grab an apple or an orange every now and then to help keep a healthy dental life.

Lastly, keeping a good dental care routine isn’t enough at all - as numerous individuals believe they’ve done adequate to last their teeth and gums a long time, there could still be a few problems popping up so every 6 months, ensure that you make an appointment and visit your dentist for your regular dental check-up. They will perform cleaning sessions (prophylaxis) and help you detect any signs of gum diseases.

Gingival swelling/gingival Enlargement

Cause of gingival swelling /Classification of gingival enlargement

1.       Inflammatory enlargement

·         Chronic

·         Acute

2.       Drug induced enlargement

3.       Enlargement associated with systemic disease

·         Conditioned enlargement

Ø  Pregnancy

Ø  Puberty

Ø  Vitamin c deficiency

Ø  Plasma cell gingivitis

Ø  Non-specific conditioned enlargement

·         Systemic disease causing gingival enlargement

Ø  Leukaemia

Ø  Granulomatosis diseases

4.       Neoplastic Enlargement

·         Benign tumors

·         Malignant tumors

5.       False enlargement

Acute inflammatory enlargement

		Gingival abscess	Periodontal abscess		Periapical abscess	Pericoranal abscess
Location		Localised swelling affecting the marginal & interdental gingiva	Usually effects deeper periodontal structures including deep pockets,furcations & vertical osseous defects & located beyond the mucogingival junction		Usually seen near the root apex	Seen in Incompletely erupted teeth
Etiology		Impaction of foreign objects in previously healthy sites.	Periodontal pocket related to destruction by periodontitis.		Due to dental caries involving the pulp	Plaque induced inflammation of the pericoronal flap
Associated clinical findings		Gingiva appear to be red,swollen & extremely painful & sometimes impacted foreign object may still be embedded in to the gingiva	Associated with periodontal pocket,tooth elevation, mobility, tender on lateral percussion		Tooth is tender on percussion	Gingiva apeears red, erythematous,swollen & extremely painful, food impaction
Radiographic features		No bone loss is evident	Bone loss is seen. Radiolucency along the lateral border of the root		No bone loss.periapical radiolucency	Impacted tooth
Treatment	Incision & drainage followed by saline mouthwash every 2 hrs.		Drainage through pocket, scaling & curratage, systemic antibiotics	RCT, extraction		Incision & drainage.

Gingival swelling/gingival enlargement(gingival abscess)

Chronic inflammatory gingival enlargement

Chronic gingival enlargement/Gingival swelling

Etiology

• Prolonged exposure of dental plaque due to poor oral hygiene.
• Food impaction
• Habit such as mouth breathing

Treatment

• Scaling & curettage
• Surgical removal-gingivectomy, flap operation

Gingival enlargement due to drugs/Gingival swelling

Many drugs may cause gingival enlargement or gingival swelling.

Drug-induced gingival enlargement/gingival swelling

Anticonvulsant drug like dilantin sodium, phenytoin.,Cyclosporine(Immunosupressive agent used to prevent organ transplantation rejections & to treat several diseses of autoimmune origin.)Nifidipine(calcium channel blocker used in hypertention)

Clinical features

• The gingival enlargement usually becomes apparent in the first three months after anticonvulsant drugs and is most rapid in the first year.
• The gingival enlargement is generalised throughout the mouth, but it is most severe in maxillary & mandibular anterior region.It starts as a painless,bead like enlargement  of gingival margins & interdental papillae.
• As the condition progresses, the marginal & papillary enlargement unite & develop into a missive tissue fold covering a considerable portion of the crown & may interfere with the occlusion.
• The surface of gingival shows an increase in stippling & finally acauliflower, warty or pebbled surface.
• As the gingival enlargement increases, the gingival tissue becomes lobulated & clefts are seen between each enlarged gingival.
• It does not occur in edentulous spaces.
• It may be present in mouths with little or no plaque and assent in mouths with abundant deposits.
• The presence of the gingival enlargement makes plaque control difficult, resulting in secondary inflammatory process that complicates the gingival swelling.

Treatment of gingival enlargement

First step:-

1. Oral hygiene reinforcement, chlorhexidine gluconate rinses, scaling & root planning.
2. Possible drug substitution-When it is attempted it is necessary to allow at least a period of 6-12 months between the discontinuation of the offending drug & the possible resolution of gingival enlargement.

Second step:-

• If the enlargement persists even after above treatment, surgical therapy is indicated.-for small areas of gingival enlargement-gingivectomy, with larger areas flap surgery may be indicated.

Gingival enlargements associated with systemic diseases
Conditioned enlargement

	Etiology	Clinical feature	Treatment
Pregnancy(marginal gingival enlargement)	Altered tissue metabolism (increased in estrogen & progesterone.) Pregnancy accentuates the response to local irritation	Gingival enlargement is more prominent interproximally Colour-Gingiva is bright red in colour, soft & friable & has a smooth shiny surface Bleeding occurs spontaneously or on slight provocation.	Meticulous plaque control, scaling & root planning. Second trimester is safe for treatment.
Pregnancy tumour	It usually occur in first trimester but can occur early also	Discrete, mushroom like spherical mass, that protrudes from the gingival margins or more frequently from the interproximal space & are attached by sessile or pedunculated base. It is usually painless, unless its size and shape foster the accumulation of debris under its margin or interfere with occlusion, in which cases painful ulcerations may occur.	Surgical excision is required which is possible should be postponed until postpartum. During pregnancy the lesion should be removed surgically only when it interferes with mastication & causes severe disfigurement & if the patient willingly wants to get it removed.
Gingival enlargement in puberty	Altered endocrine disturbance with local factor. More common in 11-17 years of age.	Occurs in both the sex. Many involve marginal gingiva & interdental gingiva. It is characterized by prominent bulbous interproximal papillae. Sometimes only facial gingiva is enlarged as the mechanical action of the tongue prevents heavy accumulation of local irritants on the lingual surface. After puberty, the enlargement undergoes spontaneous reduction, but does not disappear until local irritants are removed.	Scaling, curettage and oral hygiene instructions. Surgical removal may be performed in severe cases.
Plasma cell gingivitis	It is allergic in origin & is caused by some ingredients in chewing gums, dentifrices or various diet components	More common in women & young adults. Red, friable sometimes granular & bleeds easily. Located on oral aspect of attached gingiva.	Cessation of exposure to allergens resolve the lesion.
Vitamin C deficiency	Deficiency of vitamin C	Marginal gingiva is involved. Gingiva is bluish red, soft, friable has smooth, shiny surface. Tissue is spongy,hyperemic & bleeds spontaneously	Supplements of vitamin C
Granuloma pyogenicum	Trauma	Localised, discrete spherical tumor like mass with pedenculated attachment to a flattened keloid like enlargement having broad base. Bright red or purple & can be friable or firm. Surface exudation & purulent exudation.	Removal of lesion along with the elimination of local irritating factors.

gingival enlargement

gingival enlargement

Gingival enlargement

Systemic disease causing gingival enlargement

Leukemia

• The gingival enlargement may be diffuse or marginal, localised or generalised.It may appear as an oversized extension of the marginal gingiva or a discrete tumor like interproximal mass.
• The gingiva appears as a bluish-red with a shiny surface.
• The consistency is moderately firm but there is a tendency towards friability & hemorrhage occuring either spontaneously or on slight provocation.
• True leukemic enlargement occurs commonly in acute leukemia but may also be seen in sub-acute leukemia.It seldom occurs in chronic leukemia.
• Treatment-After the acute symptoms subside,attention is directed to correct the gingival enlargement.The local deposits are removed to control inflammatory components of the enlargedment.
• Enlargement is treated by scaling & curettage which is carried out in stages under topical anesthesia.
• Antibiotics are administered systemically the evening before & for 24 hours after each treatment to reduce the risk of infection.

Granulomatous disease

	Wegener’s Granulamatosis (multisystem granuloma)	Sarcoidosis
Etiology	Immunologically-mediated tissue injury	Unknown, but may be impaired cell-mediated immunity
Location & Distribution	Papillary enlargement	Non-specific
Clinical features	Shows oral mucosal ulceration, reddish purple gingival enlargement, bleeds on stimulation, abnormal tooth mobility, exfoliation of teeth & delayed healing response.	Red, smooth enlargement

Neoplastic gingival enlargement

Benign tumors of the gingiva

	Etiology	Location & distribution	Clinical features
Fibroma	Reaction to trauma or chromic irritation	Localised,diffuse & discrete	Slowly growing spherical mass that tends to be firm & nodular, but may be soft & vascular. Usually pedunculated
papilloma	Mostly due to papilloma virus some unknown	Localised,diffuse & discrete	Hard,wart like protuberance from gingival surface.
Peripheral giant cell granuloma	Local injury	Interdental or form gingival margin.frequently on labial surface.	Smooth regularly outlined mass to irregular in shape, multilobulated.painless.Firm or spongy & color varies from pink to deep red or purpalish.Ulcerations are seen
Central giant cell granuloma	History of injury	Mandible is most commonly involved. More common in anterior segment & does not uncommonly cross midline.	Arises with in the jaw and produces cavitaton.No pain.Slight to moderate bulging of jaw due to expansion of cortical plate.
Leukoplakia	Tobacco, chronic irritation,alcohol,syphilis,vitamin deficiency,hormones,candidiasis	Buccal mucosa,commissures,alveolar mucosa,tongue,lpis,hard & soft palate,floor of mouth & gingiva	Varies from grayish-white, flattened scaly lesion to athick irregularly shaped keratinous plaque.
Gingival cyst	Remnants of dental lamina, enamel organ, epithelial islands of periodontal membrane, traumatic implantation of epithelium.	Mandibular bicuspids,cuspid Incisor area	Painless & cause erosin of bone with expansion

Malignant tumors of gingiva

• Carcinoma
• Malignant melanoma

False enlargement of gingiva/Gingival swelling

These are not true enlargements of gingival tissues but may appear as a resulat of increase in size of the underlying osseous or dental tissues.