Periodontal Gum Disease and Inflammation: Which Happens First?
What is Periodontal Disease and Gum Inflammation
The inflammation of the human gum is referred to as gingivitis. It is caused by the build of bacteria in the gums. A severe form of gingivitis is known as periodontitis. Both diseases are a major cause of tooth loss among the adult population.
According to the Centre for Disease Control and Prevention (CDC), severe gum disease affects about 9% of adults in the United States. Estimates put it that nearly half of the adult population aged 30 years or older in the United States do show signs of gum disease.
Poor oral hygiene is the most common cause of gingivitis. And thankfully, it can be prevented and treated with good oral hygiene practices that include brushing at least twice a day, and scheduling routine dental inspections.
Both gingivitis and periodontitis are marked by the inflammation of the gums, where they become swollen, reddened, and puffy. A condition that can cause serious discomfort.
Before we go on to look at what gingivitis and periodontitis really are, let’s have a clearer view of why inflammation occurs in the human body, and how it can affect the gums.
How Does Gum Inflammation Happen?
When tissues are harmed by infection, heat, toxins, or any other cause, an inflammatory response or inflammation takes place. Chemicals like histamine, bradykinin, and prostaglandins are released by damaged tissue. As a result of the action of these chemicals, the blood vessels leak fluids into the tissues, and cause them to swell.
Our body's immune system is essentially mobilized to fight when it detects an attack taking place. It gathers an entire army of immune cells. Our body is able to do this by releasing substances known as inflammatory mediators, which act to attract other immune cells to the site of attack. To reach the damaged tissue, these immune cells cross blood arteries and traverse the bloodstream — an action that causes the blood vessels to become bigger and even more permeable. It is for this reason that damaged tissue becomes red, and swollen; a characteristic of acute inflammation.
Acute inflammation normally only lasts a few minutes but develops quickly, takes part in many of the defense mechanisms that act to destroy invasive bacteria, repair broken cells and remove dead ones. Through this cycle, the afflicted area is brought back under control and to its original state, and the inflammation goes away within a few hours or days.
So, inflammation doesn’t start when infection is developing, instead, it occurs when the body is trying to fight the activity of a harmful irritant or microorganism that is trying to wreak havoc on its tissues. Therefore, inflammation is just a signaling process that is triggered to protect organisms against infection and/or harm.
What Causes Gum Inflammation?
Like we have seen earlier, inflammation can occur as a result of the effects of things like toxins, heat, or certain bacteria. Established findings have put the most common causes of inflammation to be:
Pathogens like bacteria, fungi, or viruses. Just like the case with gingivitis or periodontitis, which are caused by the buildup of bacteria in the tissues of the mouth.
Effects of certain chemicals or radiation.
Open wounds such as scratches or injury from foreign items.
What are the Signs of Acute Gum Inflammation?
The most common signs that show inflammation of a tissue are redness, pain, swelling, and even loss of function. Yes, inflammation can cause decline in the functioning of an affected area. A typical example include the loss of smell that occurs when a person is battling with viral infections like flu and cold. Other examples are not being able to move and swing a swollen joint properly, and the difficulty that is encountered when trying to breath during bronchitis.
While most inflammations do come with the above signs and symptoms, there are others that occur silently without any symptoms.
How Does Gum Inflammation Cause Periodontal Disease?
Now that we have an idea about how inflammation occurs, let’s see why it’s connected to gum disease. Like we have mentioned earlier, the inflammation of the gums in referred to as gingivitis. It is the early stage of gum disease, and is characterized by the inflammation of the gingiva, which is the tissue of the upper and lower jaws that surround the base of the teeth. The gingiva or gum is pink-colored, and keratinized. It helps protect and hold our teeth in place.
Just like we have seen earlier, inflammation can only occur when a tissue has been damaged by toxins, pathogens, injuries, or certain external forces. In the case of gingivitis or gum inflammation, bacterial buildup is the root cause. This buildup occurs in the form of plaque and tartar.
If you are not aware, plaque, also known as biofilm, is a white layer of bacteria that accumulates on our teeth. The bacteria in our mouths feed on the carbohydrates from the foods we eat, and as a result, release acids in our mouth. These acids have the potential to weaken the enamel and raise the possibility of developing cavities. When these acids come in contact with the gum, it can cause it to become swollen and irritated. Plaque will also eventually harden into tartar, causing your gums to swell up and bleed easily, which is a precursor to gum disease. Besides, plaque can also easily develop under the gums, or on the tooth roots, where it can break down the bones that support the teeth.
Do I have Periodontal Disease or Gingivitis?
As we have mentioned earlier, a severe form of gum disease or inflammation known as periodontitis can occur if gingivitis remains untreated.
Gingivitis, or gum inflammation, is always the precursor to periodontitis. The inflammation in periodontitis is usually the body's way of responding to bacteria that have been allowed to build up on the teeth, and it typically includes reddish or swollen gums and bleeding when cleaning the teeth or chewing on food.
Periodontal inflammation may further migrate along the tooth roots and below the gum line, and cause the supporting bone and the tissues around the teeth, also known as the periodontal ligament, to suffer long-term damage. As a result, teeth may begin to loosen and may eventually fall out.
Unlike gingivitis that’s characterized by acute inflammation, periodontitis is caused by chronic inflammation. If you are not aware, the phrase "chronic inflammation" refers to a long-term and slow inflammation that can last for months or years. The severity and implications of chronic inflammation typically depend on the nature of an injury and the body's ability to heal and repair the damage.
According to scientific findings, chronic inflammation can occurs as a result of:
Exposure to a little quantity of an irritant or foreign substance that cannot be removed from the body through enzymatic processes or even phagocytosis.
An autoimmune condition where the immune system mistakenly identifies a healthy body tissue as a foreign substance and attacks it, leading to disease
Inflammatory and biochemical inducers, such as elevated levels of free radical molecules, advanced glycation end products (AGEs), uric acid (urate) crystals, oxidized lipoproteins, homocysteine, and others, that cause oxidative stress.
An abnormality in the cells that mediate inflammation.
Prolonged bouts of acute inflammation.
Failure to eliminate the cause of an acute inflammation, such as infectious agents like certain bacteria, protozoa, fungi, and other microorganisms that can withstand host defenses and persist in the tissue for a long time. This particular cause is peculiar to conditions like periodontitis, where it evolves from an acute inflammatory stage in gingivitis, to a chronic stage, as a result of persistent presence of harmful bacteria in the mouth tissues.
Is Chronic Inflammation Associated with Periodontitis?
The main cause of death worldwide is chronic inflammatory disorders. The greatest danger to human health, according to the World Health Organization (WHO), is chronic diseases. For the next 30 years, it is expected that chronic inflammation-related disorders would become more common in the United States.
In a research published in the Frontiers in Physiology Journal, the inflammation associated with periodontitis has been found to have a possible link to conditions like vascular disease due to shared inflammatory pathways. This link is thought to be as a result of the activity of reactive oxygen species or oxidative stress. Another research found that people with periodontal disease have two or three times higher risk of a cardiovascular attack like stroke and heart attack.
Apart from raising your risk of other chronic diseases, periodontitis can cause early loss of teeth, problems with food chewing, and even impact your smile, aesthetically.
How Do I Fighting Gum Disease?
When you notice signs and symptoms, like swollen and red gums, bleeding, tender gums, bad breath, painful chewing, gums that have drifted away from your teeth, and any change in the fit of your partial dentures, then you are likely battling with gingivitis or even periodontitis. This means you must take vital steps to protect your oral health from the possibility of problems like tooth loose, bone deterioration, and oral decay.
Generally, good dental care and routine professional cleaning can prevent and treat gingivitis. Even more severe cases of periodontal disease can be effectively treated, although it might take longer, and with much more expensive treatments. This may include deep cleaning of the tooth root surfaces below the gum line, oral prescription drugs, gum-directed treatments, and occasionally, corrective surgery.
Complete oral care routine
Anyone looking to avoid gingivitis or periodontitis must adopt a complete oral care routine. Not only can a proper dental care help protect you from gingivitis, it can also help fight the early stage of the disease by helping you overcome the presence of plaques on your teeth. Some of the best oral care practices include regular teeth brushing, flossing, and rinsing with mouthwashes.
Brushing your teeth at least twice daily is the most straightforward technique to get rid of plaque. You can use a gentle toothbrush for this purpose. It is also important to remember to replace it when the bristles start to fray, may be every three to four months. You can also go for the option of using an electric toothbrush, which has the potential to be more efficient in removing plaque than a conventional one.
An essential dental hygiene habit is flossing. It removes food materials that have been caught between your teeth and cleans your mouth, thereby reducing the amount of bacteria and plaque therein. To remove food and plaque that has become trapped between your teeth, floss once a day using dental floss or a water flosser. According to findings, flossing eliminates even more plaque than your regular teeth brushing.
Mouthwashes with antimicrobial ingredients can reduce plaque accumulation and protect against gingivitis. However, it is advised that you only use a gentle mouthwash that won't irritate your gums.
Limit sugar intake
Tooth decay and sugar are closely related. On consumption, sugar-containing foods mix with saliva and oral bacteria to form plaque on the teeth. Plaque on teeth has the ability to erode enamel, which can lead to gum inflammation and the formation of cavities. Therefore, it is strongly advised that you limit your intake of sugary or sweetened foods.
Other Contributors
Although plaque is the leading cause of inflammation, other factors can also contribute to gingivitis. Your chance of getting gum inflammation might be increased by smoking, stress, being pregnant, and taking certain medications. Despite the fact that some of these factors are beyond your control, it's still a good idea to be mindful of them and discuss any potential concerns with your oral healthcare professional.
Gum disease or periodontitis occurs as a result of the buildup of bacteria in our mouth. It is characterized by inflammation of the gums, which causes redness, pain, and swelling. It usually starts with acute inflammation in gingivitis, before proceeding to a more severe condition (periodontitis) that is driven by chronic inflammation.
REFERENCES
https://www.cdc.gov/oralhealth/fast-facts/gum-disease/index.html
https://www.health.harvard.edu/staying-healthy/understanding-inflammation
https://www.healthline.com/health/dental-and-oral-health/plaque
https://www.frontiersin.org/articles/10.3389/fphys.2020.609614/full