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If your gums are swollen, tender and bleed easily when you brush your teeth, you’re not alone â€” nearly 80 percent of American adults have some form of gum (periodontal) disease. One of the most common of these is gingivitis, which develops when bacteria multiply and build up between your teeth and gums, leading to irritation, inflammation and bleeding. If not treated, gingivitis can progress to more-serious gum diseases, such as periodontitis, and eventually to the destruction of bone and to tooth loss.
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Yet gingivitis is both preventable and treatable. Although factors such as medications and lowered immunity make you more susceptible to gingivitis, the most common cause is poor oral hygiene. Daily brushing and flossing and regular professional cleanings can significantly reduce your risk of developing this potentially serious condition. If you already have gingivitis, professional cleaning can reverse the damage.
Signs and symptoms
Because early-stage gum disease is seldom painful, you can have gingivitis without even knowing it. Often, though, you’re likely to have warning signs such as:
Swollen, soft, red gums.
Gums that bleed easily, even if they’re not sore. Many people first detect a change in their gums when they notice that the bristles of their toothbrush are pink a sign that gums are bleeding with just slight pressure.
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Gingivitis begins with plaque. This invisible, sticky film, composed primarily of bacteria, forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque, but it re-forms quickly, usually within 24 hours.
Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. What’s more, you usually can’t get rid of tartar by brushing and flossing you’ll need a professional cleaning to remove it.
The longer plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.
Although plaque is by far the most common cause of gingivitis, other factors can contribute to or aggravate the condition, including:
Drugs. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body’s production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily.
Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes can lead to an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
Viral and fungal infections. Although bacteria are responsible for most cases of gingivitis, viral and fungal infections also can affect your gums. Acute herpetic gingivostomatitis is an infection caused by the herpes virus that frequently leads to gum inflammation and to small, painful sores throughout your mouth. Oral thrush, which results when a fungus normally found in your mouth grows out of control, causes creamy white lesions on your tongue and inner cheeks. Sometimes these lesions spread to the roof of your mouth, your tonsils and your gums.
Other diseases and conditions. Some health problems not directly associated with your mouth can still affect your gums. People with leukemia may develop gingivitis when leukemic cells invade their gum tissue. Oral lichen planus, a chronic inflammatory disease, and the rare, autoimmune skin diseases pemphigus and pemphigoid can cause gums to become so severely inflamed that they may peel away from the underlying tissue.
Hormonal changes. During pregnancy, your gums are more susceptible to the damaging effects of plaque. The problem is compounded if you have morning sickness â€” nausea and vomiting may make it hard to brush your teeth regularly.
Poor nutrition. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It’s also a powerful antioxidant that counters the tissue-destroying effects of free radicals â€” substances produced when oxygen is metabolized by your body.
Although anyone can develop gingivitis, many people first experience gum problems during puberty and then in varying degrees throughout life. The most common contributing factor is lack of proper oral hygiene, but other factors also can increase your risk, including:
Tobacco use. Cigarettes, cigars, pipe smoking and chewing tobacco all promote the growth of bacteria in your mouth and weaken your immune system, making you more vulnerable to infection. In addition, gingivitis treatments are less likely to be effective if you use tobacco.
Diabetes. If you have diabetes, elevated blood sugar levels can damage many parts of your body â€” and your mouth is no exception. Diabetes increases your risk of cavities, gingivitis, tooth loss and a variety of infections. It also makes it more likely that you’ll have a dry mouth, which further increases your risk of gum disease.
Decreased immunity. If you have a weakened immune system, you’re more susceptible to infections of all kinds, including gum infections.
When to seek medical advice
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, see your dentist. The sooner you seek care, the better your chances of reversing damage and preventing more-serious problems.
Untreated gingivitis can progress to periodontitis, a much more serious form of gum disease. Periodontitis can cause tooth loss and may even increase your risk of heart attack and stroke. What’s more, women with periodontitis are far more likely to give birth to premature babies than women with healthy gums are.
Your dentist may treat gingivitis in several ways, but the first step is to thoroughly clean your teeth, removing all traces of plaque and tartar â€” a procedure known as scaling. The cleaning may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup.
Gingivitis usually clears up after a professional cleaning as long as you continue to follow a program of good oral hygiene at home. Your dentist may recommend using an antiseptic mouth rinse in addition to brushing and flossing.
At first your gums may bleed after brushing, but this usually lasts just a few days. If you persist, you should see pink, healthy gum tissue in a short time. You’ll need to practice good oral hygiene for life, however, so your gum problems don’t return. Because misaligned teeth and poorly fitting crowns and bridges make it harder to remove plaque, your dentist may recommend fixing these problems as well.
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The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily in the morning and before going to bed â€” and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.
In addition, follow these tips to keep your gums and your children’s gums healthy. Children as young as 6 can develop gingivitis.
Choose the right toothbrush. Select a toothbrush with soft, end-rounded or polished bristles â€” stiff or hard bristles are more likely to injure your gums. The size and shape of the brush should allow you to reach every tooth. Remember that only the tips of the brush do the cleaning so there’s no need to exert extra pressure. Replace your brush every three to four months or even more often. If the bristles are splayed, you’ve waited too long.
Consider investing in an electric toothbrush with rotating or vibrating bristles. Studies have shown these types of toothbrushes to be more effective at removing plaque and maintaining healthy gum tissue than are manual brushes.
Brush as if your teeth depended on it. Brushing doesn’t do much good if you don’t do it correctly. Here’s what works: To clean outer surfaces of your teeth and gums, use short, back-and-forth, and then up-and-down strokes. Use vertical strokes to clean inner surfaces. To clean the junction between your teeth and gums, hold your brush at a 45-degree angle to your teeth.
Floss. If you’re like most people, this is the part of oral care you tend to ignore. It’s true that flossing is a tedious job, which may be why most dentists find their patients don’t floss regularly. But flossing is the most effective way to remove plaque and food particles from between your teeth, where toothbrush bristles can’t reach.
To make sure that all the effort you put into flossing is rewarded, be sure you do it correctly. Here’s the drill: Use about 18 inches of waxed or unwaxed floss. Hold the floss taut and bent around each tooth in a C shape, scraping up and down each side of each tooth. Each stroke should go slightly below your gumline until you feel resistance. Flossing removes plaque between your teeth and helps massage your gums.
Pay attention to the brushing action, not the type of toothpaste. Some toothpastes claim to remove plaque and tartar or to kill the bacteria that cause plaque. The truth is that all toothpastes, including natural ones without additives of any kind, remove plaque if you brush properly. And no product can remove tartar below your gumline, although anti-tartar or tartar control toothpastes can help prevent tartar from building up on your teeth. The bottom line? When used properly, inexpensive fluoride toothpastes remove plaque just as thoroughly as specialty toothpastes â€” it’s the brushing action, not the toothpaste, that removes plaque.
See your dentist. In addition to daily brushing and flossing, see your dentist or hygienist for regular checkups and cleanings.
Complementary and alternative medicine
Because nutrition plays a major role in oral health, many complementary and alternative therapies focus on supplying your body with certain nutrients. Some of these include:
Coenzyme Q10 (CoQ10, ubiquinone). This substance, which occurs naturally in your body and in a wide variety of foods, plays a key role in the production of cellular energy. It’s also a powerful antioxidant â€” many times more potent than vitamin C. Researchers have studied the potential effect of CoQ10 on a number of conditions, including Parkinson’s disease, Alzheimer’s disease, cancer, cardiovascular disease and periodontal disease. Among other findings, CoQ10 applied to pockets of diseased gum tissue appears to reduce infection, but no studies have measured the effectiveness of oral CoQ10. You can purchase CoQ10 supplements at natural foods stores and some pharmacies. Look for oil-based capsules, which are far better absorbed and utilized than dry capsules are.
Vitamin C. A potent antioxidant and major player in the synthesis of collagen, vitamin C is essential for healthy gums. Many fruits and vegetables, including citrus fruits, berries, cantaloupe, broccoli and spinach, are rich sources of vitamin C, and most natural foods stores and pharmacies carry vitamin C supplements. Whether you get Vitamin C from food or supplements, many dentists suggest getting at least 1,000 milligrams of vitamin C a day to help treat and prevent periodontal disease.
Grapefruit seed extract. This natural extract has proven antibiotic qualities. Some people suggest adding a drop to your regular toothpaste every time you brush. Look for grapefruit seed extract in natural foods stores or online.
Cranberries. They’re not just for Thanksgiving anymore. Long known as a treatment for urinary tract infections, cranberries and cranberry juice work by preventing bacteria from adhering to cells that line the bladder. Now it appears that cranberries may also keep bacteria from sticking to your teeth and gums. Unfortunately, most cranberry products have sugar added, which can undo the beneficial dental effects. Look for products sweetened with other fruits or fruit juices rather than with sugar. Suggested dose is 3 ounces of juice or six cranberry tablets daily. If you have a tendency to kidney stones or are taking the blood thinner warfarin, talk with your doctor before starting on a cranberry regimen.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.