Abstract
Gum inflammation is a gingival disorder which is characterized by soreness, reddening and pain in gums. The source of such inflammation is an auto-immune reaction of the body within the oral cavity as a response to a negative impact of bacterial, chemical, physical or other nature. Apart from the most popular form of gingival inflammation due to decay, which is perceived as the prevalent form of gingivitis and may lead to subsequent periodontitis, there are several other factors that can contribute to gum inflammation of seemingly healthy people. These factors have uncommon origin and may require different methods of treatment. The aim of this literature review is to determine main risk factors of gingival inflammation apart from decay-related gingivitis, classify them and assess the possible measures of its prevention according to various scientific sources.
Keywords: gum inflammation, gingivitis, prevention
Purpose
The choice of the topic of gingival inflammation among various groups of patients is logical and reflects the current level of development of dental medicine. The most prevalent form of gum inflammation is plaque-related, and it has been widely described in a range of academic sources. However there are other, less researched origins of gum inflammation which may occur due to different reasons.
The purpose is to classify such origins and their ways of treatment, as well as present the factual evidence of diversity of reasons that may cause gingival inflammation also among otherwise healthy individuals.
Literature review
According to the commonly accepted definition gum inflammation is clinically characterized by gingival redness, swelling and increased tendency of bleeding of the soft tissue.
The typology of gum inflammation as a gingival disorder consists of the following subdivisions:
- Dental plaque-induced gingival diseases common gingivitis).
- Gingivitis associated with plaque only
- Gingival diseases modified by systemic factors
- Gingival diseases modified by medications
- Gingival diseases modified by malnutrition
- Non-plaque-induced gingival lesions
- Gingival diseases of specific bacterial origin
- Gingival diseases of viral origin
- Gingival diseases of fungal origin
- Gingival diseases of genetic origin
- Gingival manifestations of systemic conditions
- Traumatic lesions
- Foreign body reactions
- Not otherwise specified
The first group is most widely described in analytical research literature, both within peer-reviewed journals and beyond. As for the other one, among risk factors for the emergence of non-plaque related gingival disorders, the following factors were named according to the article “Periodontal (Gum) Disease: Causes, Symptoms and Treatments” (NIH, 2012):
- Smoking, as a factor which contributes to the chemical disbalance of the oral cavity and gums, in particular;
- Hormonal changes in women. Due to the reasons of hormonal nature, as it was specified in the article, gum sensitivity may increase considerably and therefore provoke inflammation;
- Diabetes, as it was proven that carriers of this disease were more sensitive to various infections, including those of gingival nature;
- Heavy chronic diseases (AIDS, cancer) and their treatment were proven as factors lowering immunity and increasing the chances of subsequent gingival inflammation;
- Certain forms of medications which decrease the flow of saliva and prevent the immune system from responding to factors which threaten gingival areas;
- Genetic susceptibility, as some people are more predisposed to certain categories of disorders than other due to genetic reasons.
There are, however, other, more exotic reasons for non-standard gingival inflammation, which are sometimes difficult to detect and describe by traditional means of dental nomenclature. In her article “Inflammation of the gingivia: The other reasons besides the obvious”, Doctor Denise A. Trochesset named several of them (2013):
- Pemphigus vulgaris – a serious infectious disease which has to be treated by dermatologists by mean of immunosuppressant and immunomodulators.
- Mucous membrane pemphigoid – long-lasting partial inflammation treated by ointment.
- Lichen planus – although visually similar to plaque, originates from other groups of bacteria. It is best treated by tropical corticosteroids.
- Lichenoid mucositis – an allergic reaction of gums to certain kinds of products.
There are two main ways of treatment of gingival inflammation – medication and surgical treatment. The former is represented by prescription antimicrobial mouthrinses, antiseptic chips, various forms of antibiotic gels, antibiotic microspheres, enzyme suppressants and oral antibiotics (NIH, 2012). Apart from these forms of treatment, there were also several prophylactic measures described in professional literature.
First of all, those are special forms of powered toothbrushes. As described in the article “Different powered toothbrushes for plaque control and gingival health (Review)” (Deacon, S.A. et al, 2011, p.2), various experiments conducted since 1960-ies proved that there was a positive correlation between of the usage of powered toothbrushes instead of traditional ones, and decrease of gingival inflammation of the respondents. Due to this reason massaging gums proved to be one of the efficient factors of gingival inflammation prevention.
Other means of prophylaxis of gum inflammation include ultrasonic massaging of gums. Such procedure prevented massive gum inflammations despite other risk factors within 15-30 days till its start.
The research of the new methods of preventing and treating the emerging gingival inflammation also recently included application of various substances. It was proved by a research reflected in the article “ Common therapeutic approaches for the control of oral biofilms: microbiological safety and efficacy” (Gilbert, P. et al, 2007) that traditional triclosan remained a strong remedy against inflammation, especially at later stages. New substances have been also under development within the past few years. The recent U.S. patent “Method and composition for treating oral bacteria and inflammation” (D’Amelio, Sr. et al, 2010), for example, provided a new method of medical treatment based on folic acid, aloe vera, coenzyme Q10 and certain herbal extracts.
Apart from medical treatment, however, there is also a possibility of surgical measures in the most serious cases. NIH (2012) pointed out the two main surgical methods: flap surgery and bone and tissue graphts.
Methods and Procedures
For the purpose of this literature review various sources have been used. First of all, it included research of peer-reviewed scientific articles, such as “Different powered toothbrushes for plaque control and gingival health (Review)” (Deacon, S.A. et al, 2011), “Common therapeutic approaches for the control of oral biofilms: microbiological safety and efficacy” (Gilbert, P. et al, 2007).
Other sources were also used, including popular articles on dentistry -“Inflammation of the gingivia: The other reasons besides the obvious” (Trochesset, D.A., 2013) and “Periodontal (Gum) Disease: Causes, Symptoms and Treatments” (NIH, 2012).
Finally, a patent-related source was also assessed in order to provide the most comprehensive description of the problem and its possible solution.
The topic of this research was selected throughout intensive search of relevant materials by means of search engines Google and Google Scholar.
Discussion
The issue of gingival inflammation, despite its seeming simplicity, contains many interesting details. The common public is used to perceiving it as a result of gingivitis, which in its turn originated from certain forms of bacterial activities in the oral cavity, and is relevant to plaque. The discovered information points out to the fact that gum inflammation may have other origins and is often witnessed among otherwise healthy people. The method of inflammation prevention and treatment may be similar to those used against gingivitis, but may be also quite different.
Analysis of Strengths and Weaknesses
The papers which were used within this research were indeed properly and academically written and contained various important data. On the other hand, none of those sources reflected the particular issue of gum inflammation among healthy individuals, therefore making respective search and analysis somewhat problematic.
Conclusion
The issue of gum inflammation apart from cases of proven gingivitis is still under development, and a lot of empirical research is to be made in order to identify the main points of concern.
References
Deacon, S.A. et al, 2011. Different powered toothbrushes for plaque control and gingival health (Review). Cochrane Library, 2011, Issue 6, p. 1-45. Web. Retrieved from http://www.update-software.com/bcp/wileypdf/en/cd004971.pdf
Gilbert, P. et al, 2007. Common therapeutic approaches for the control of oral biofilms:
microbiological safety and efficacy. Clinical Microbiological Infections 2007, Vol. 13, No. 4, p. 17-24. Web. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2007.01800.x/pdf
Trochesset, D.A., 2013. Inflammation of the gingivia: The other reasons besides the obvious. Dentistry iQ Network. Web. Retrieved from http://www.dentistryiq.com/articles/2013/03/inflammation-of-the-gingiva-the-other-reasons-besides-the-obviou.html
Periodontal (Gum) Disease: Causes, Symptoms and Treatments (2012). National Institute of Dental Health and Craniofacial Research (NIH). Web. Retrieved from http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm
D’Amelio, Sr. et al, 2010. Method and composition for treating oral bacteria and inflammation. U.S. Patent Bureau, Patent No. US 7,829,067 B2. Web. Retrieved from http://www.google.de/patents?hl=en&lr=&vid=USPAT7829067&id=ipjZAAAAEBAJ&oi=fnd&dq=%22gum+inflammation%22&printsec=abstract#v=onepage&q=%22gum%20inflammation%22&f=false
