Gingivitis is a periodontal disease which affects the tissues at the neck of teeth, i.e. gums. The most common type of gingivitis is chronic gingivitis; this condition can be reversed with treatment by a dentist, therapist or hygienist and can be prevented by maintaining good oral hygiene.
There are signs that patients can look out for that show the early stages of gingivitis have begun;
- Gums bleed when brushing teeth
- Gums appear to be red (rather than pink) and are swollen
- Bad breath (halitosis)
- Plaque is present at the cervical margins (where gum meets tooth)
Plaque is the main factor in gingivitis occurring. Plaque is a thin, sticky, colourless film which coats the teeth. Plaque contains micro-organisms and food debris, and begins to form within a short period of time after brushing. As food debris adheres easily to plaque, once plaque is present it can build up rapidly. If plaque is not effectively removed regularly, gingivitis can occur.
Chronic gingivitis is the name given to the periodontal condition affecting gums if there is evidence that it is generalised throughout the whole of the oral cavity.
Gingivitis occurs when
- Plaque is present at gingival margins and is not removed effectively
- The plaque film grows and bacterial toxins are produced from micro-organisms within the plaque
- Gums (gingiva) become red and inflamed when in contact with toxins
- The inflammation of the gingiva causes pockets to appear between the neck of the tooth and gum. These are called false pockets as they will disappear if effectively treated quickly by a dental care professional
- As cleaning these pockets is difficult more plaque accumulates
- Plaque eventually calcifies and becomes calculus (tartar), which cannot be removed without the use of dental instruments
- Calculus has uneven surfaces and therefore attracts more plaque still, this aggravates the bacterial toxins that are already present and tiny (microscopic) ulcers are formed which cause the gingiva to bleed when probed or brushed
Calculus can sit on tooth tissue either above the gum (known as supra-gingival calculus), or beneath the gum (known as sub-gingival calculus). Supra-gingival calculus is yellow in colour, and sub-gingival calculus is brown. Calculus is a hard substance which sticks to teeth.
Gingivitis can be reversed if calculus and plaque are removed from the tooth surfaces while the pockets that have formed are still ‘false’. Gingivitis is treated by providing patients with regular scaling and polishing, this treatment is carried out by a dentist, a dental therapist or a hygienist. Calculus is removed in surgery by instruments known as scalers.
Scalers are available as hand instruments or ultrasonic instruments. They vary in shape, size and length and are specifically designed to be used on certain teeth and to be used with a particular action, they are extremely sharp instruments. Hand scalers are used by dental care professionals to scrape away any calculus and leave a smooth tooth/root surface where it is more difficult for plaque to accumulate. Examples of scalers include;
- Sickle scaler
- Jaquette scaler
- Periodontal hoe
- Push (Cushing) scaler
- Periodontal curette
Ultrasonic instruments work by vibrating; this ultrasonic vibration loosens calculus from the tooth surface enabling calculus to effectively be removed. The ultrasonic vibration reaches the scaler tip by travelling down a cable from an ultrasonic unit (machine), through a handpiece along to the removable scaler tip. To prevent the scaler tips from overheating they have cool water constantly flowing onto the tip. The water also enables the calculus and plaque to be flushed away from the pockets being treated. Ultrasonic scaling can be slightly uncomfortable for patients, particularly those who suffer from sensitivity; however scaling can be done under local anaesthetic if patients prefer.
Once all calculus and plaque are removed from teeth the dentist, therapist or hygienist will polish the teeth with a paste known as prophylactic paste, this is an abrasive paste which removes stain and leaves the tooth surface smooth, therefore reducing the likelihood of quick re-accumulation of plaque, and allowing the periodontal tissues to return to a healthy state.
