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Gingivitis

Dental | August 3, 2018 | Author: Naturopath

dental

Gingivitis

Spitting pink foam into your sink after brushing your teeth? Tasting metal in your mouth while eating? It could be gingivitis.

Gingivitis is characterised by inflammation of the gums with bleeding, swelling and redness. Normally, the gums grip the teeth firmly and are contoured to the surface of each tooth. In gingivitis, the gums become red, swollen and “soft” – they lose their tight grip on the teeth and become slightly movable.

Plaque-induced gingivitis is caused by poor dental hygiene. When plaque accumulates between the gums and the teeth, it pushes the gums away from the teeth and forms small pockets where bacteria can grow. This bacteria irritates the gums and causes gingivitis – and it can also cause cavities in the roots of the teeth.

Along with poor dental hygiene, increased risk of plaque-induced gingivitis is due to

  • Hormone changes in adolescence, pregnancy, menopause, or from taking oral or injectable contraceptive hormones
  • Drugs that cause an overgrowth of gum tissue, such as calcium channel blockers, cyclosporin and phenytoin
  • Nutrient deficiencies, especially vitamin C and B vitamins
  • Conditions such as AIDS, diabetes, or leukaemia
  • Exposure to heavy metals like lead or arsenic
  • Smoking cigarettes
  • Alcohol abuse [1]

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Non-plaque-induced gingivitis is rare and occurs due to trauma, hereditary disorders, and oral infections. It does not respond to the same treatments as plaque-induced gingivitis but controlling plaque can prevent it from becoming worse.Symptoms of Gingivitis

Symptoms of Gingivitis

  • Gums appear red instead of pink
  • Swollen areas of gum appear around the teeth
  • Gums are soft and moveable instead of firm against the teeth
  • Gum bleed easily, especially while brushing or eating
  • Usually no pain, but there may be discomfort

Gingivitis in Pregnancy

Mild gingivitis can become worse during pregnancy due to hormonal changes. Fluctuations in oestrogen and progesterone can influence the types and numbers of bacteria found in the mouth and cause sudden inflammation in the gums [1]. Brushing your teeth in the morning is suddenly very unappealing during the months of morning sickness, adding to oral hygiene risks. Dentists recommend brushing without toothpaste or using a salt-water rinse to control plaque and oral bacteria during morning sickness.

Gingivitis from Nutritional Deficiencies

Gingivitis is a sign of scurvy, a disease caused by vitamin C deficiency. Vitamin C is required for the formation of collagen, a connective tissue that holds the gums tightly to the teeth. Along with inflamed, bleeding gums, red or purple dots and bruises can appear throughout the mouth. While scurvy is associated with pirates and the days before fresh fruit and vegetables were readily available, this condition is still prevalent in Australia. A recent study suggested that up to 14% of adults could have scurvy and not know it! [3]

B vitamins are involved in cellular repair, metabolism and proliferation. The gums are made up of rapidly dividing cells, and a deficiency in B vitamins can disrupt their structural integrity. A deficiency of vitamin B3 (niacin) causes a disease called pellagra, which causes gingivitis and a predisposition to inflammation of the tongue, and mouth infections like thrush. Pellagra is relatively rare in Australia but is common in alcohol abuse [4]. Vitamin B12 deficiency is a more common and can also cause bleeding gums, as can low levels of folate which are common in smokers.

Natural Therapies for Gingivitis

Good news – the gums are quick to respond to treatment and gingivitis usually disappears once plaque and inflammation are controlled. If plaque has formed into hard tartar on the teeth, this cannot be removed by regular brushing and flossing and requires regular professional cleaning by a dentist or hygienist.

There are natural therapies that can help to treat most cases of gingivitis and prevent its onset:

Herbal Toothpaste and Mouthwash

Regular brushing is the number one treatment for gingivitis. Not only does brushing and rinsing thoroughly remove bacteria that cause gingivitis, but the mechanical friction from the bush can strengthen the gum tissue.

Natural Therapies for GingivitisMouthwashes help to rinse away bacteria and can get into tight crevices that brushing can't reach. Consider toothpastes and mouthwashes that contain antibacterial herb extracts such as tea tree oil, cinnamon, propolis or lemongrass to further protect your gums against gingivitis.

Studies show that tea tree oil can eliminate oral bacteria and improve the healing of deep gum tissues, cinnamon has been shown to alter the microbiome of the mouth, and lemongrass can reduce gingivitis as effectively as medicated mouthwashes [10] [11] [12].

Oral Hygiene & The Right Toothbrush

Electric toothbrushes are your best bet when it comes to eradicating plaque and protecting your gums against bacteria. A 2017 trial found that electric toothbrushes consistently improve oral hygiene in the long-term, and a Cochrane review showed that using an electric toothbrush can cause reduce plaque build-up by 21% and lower the risk of gingivitis by 11% [6] [7].

Always change your toothbrush every three months to prevent build-up of bacteria in the bristles, floss daily, and use a toothbrush with soft or gentle bristles to prevent damaging or hurting the inflamed gums.

Vitamin C

Gingivitis is a sign of scurvy, the disease caused by vitamin C deficiency, which can be quickly remedied by boosting dietary intake of fresh fruit and vegetables. But you don't have to have a full-blown deficiency to benefit from taking this powerful antioxidant – studies have shown that taking just 200mg of supplemental vitamin C per day can prevent gingivitis in populations with poor oral hygiene [5].

B Vitamins

B vitamins are required for the rapid turn-over of cells in healthy gum tissues. Pellagra, the disease caused by niacin deficiency, is very rare in Australia but taking a niacin supplement may still help to support gum health. Vitamin B12 and folate as essential for controlling inflammation throughout the body and boosting their levels has been shown to strengthen the gums [9]. NOTE: B vitamins work together synergistically and should always be taken together in a B complex.

Oil Pulling

Natural Therapies for GingivitisThe Ayurvedic practice of “oil pulling” has been shown to work as an effective co-therapy for treating gingivitis. Oil pulling involves swishing oils (usually sesame or coconut oil) around the mouth for 15 – 20 minutes and is traditionally used to remove toxins and bacteria from the mouth and whole body.

A recent study found that the combination of regular brushing, flossing, and oil pulling can control plaque and inflammation better than any single treatment alone [13]. 

Salt Water Rinse

A 2016 study found that rinsing with salt water could promote gum healing during other treatments for gingivitis (such as regular brushing and anti-bacterial mouthwashes) [8]. The study found that salt initiated cellular repair of damaged gum tissue and reduced inflammation throughout the mouth. Salt rinses can also control bad breath, reduce risk of thrush, and stimulate saliva. Add ¼ of teaspoon of salt to a glass of lukewarm water, sip and swish for 30 seconds before spitting. Careful though – long-term use of salt water rinses can damage tooth enamel. Speak to your dentist for personalised advice.

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References

[1] Ubertalli, J. T. (2017) Gingivitis. Merck Manual Online Database Professional. https://www.msdmanuals.com/en-au/professional/dental-disorders/periodontal-disorders/gingivitis

[2] Wu, M., et al. (2015) Relationship between Gingival Inflammation and Pregnancy. Mediators Inflamm., 22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385665/

[3] Velandia, B., et al. (2008) Scurvy Is Still Present in Developed Countries. J Gen Intern Med., 23:8, 1281 – 1284. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517958/

[4] Thornton, A. & Drummond, C. J. (2014) An unexpected case of pellagra.  Medical Journal of Australia., 200:9, 546 – 548. https://www.mja.com.au/journal/2014/200/9/unexpected-case-pellagra

[5] Amaliya, A., et al. (2018) Effect of guava and vitamin C supplementation on experimental gingivitis: A randomized clinical trial. J Clin Peridontol. https://www.ncbi.nlm.nih.gov/pubmed/29757462

[6] Kulmarni, P., et al. (2017) Comparison of Efficacy of Manual and Powered Toothbrushes in Plaque Control and Gingival Inflammation: A Clinical Study among the Population of East Indian Region. J Int Soc Prev Community Dent., 7:4, 168 – 174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558249/

[7] Yaacob, M., et al. (2014) Powered versus manual toothbrushing for oral health. Cochrane Database of Systematic Reviews. http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD002281.pub3/abstract;jsessionid=5293040E0F63F0801A78385FF040731C.f04t03

[8] Huynh, N. C., et al. (2016) Rinsing with Saline Promotes Human Gingival Fibroblast Wound Healing In Vitro. PloS ONE., 11:7. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159843

[9] Najeeb, S., et al. (2016) The Role of Nutrition in Periodontal Health: An Update. Nutrients., 8:9, 530. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037517/

[10] Salvatori, C., et al. (2017) A comparative study of antibacterial and anti-inflammatory effects of mouthrinse containing tea tree oil. Oral Implantation., 10:1, 59 – 70.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516420/

[11] Kothiwale, S. V., et al. (2014) A comparative study of antiplaque and antigingivitis effects of herbal mouthrinse containing tea tree oil, clove, and basil with commercially available essential oil mouthrinse. J Indian Soc Periodontol., 18:3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095623/

[12] Dany, S. S., et al. (2015) Efficacy of 0.25% Lemongrass Oil Mouthwash: A Three Arm Prospective Parallel Clinical Study. J Clin Diagn Res., 9:10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625327/

[13] Naseem, M., et al. (2017) Oil pulling and importance of traditional medicine in oral health maintenance. Int J Health Sci., 11:4, 65 – 70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654187/

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