Gingivitis: Bad to the Bone

By Judy Packer-Tursman
Special to the Washington Post

Behind every smile or frown is a mouth teeming up with up to 300 kinds of bacteria. With proper oral hygiene, the "good" and "bad" bacteria remain in balance; without appropriate care, bacteria build up and help form plaque, a film on the teeth that causes periodontal, or gum, disease.

Gingivitis- an inflammation of the soft gum tissue, or gingival-s the mildest stage of gum disease. It's so common that at least half of Americans of all ages are estimated to have the problem at any given time. Typically, gingivitis is painless and reversible by daily brushing and flossing and regular dental checkups. Left untreated, though, gingivitis can lead to serious infection of tissue surrounding and supporting the teeth-ultimately damaging bone as well as gums and causing tooth loss.

Brushing, Flossing, and Beyond

Dental professionals agree that tenderness from routine brushing should be taken seriously.

"Bleeding from the gums are never healthy," says Michael K. McGuire of Houston, president of the American Academy of Periodontology. He urges people not to let infected and bleeding gums dissuade them from brushing and flossing: in a few weeks their gums will be healthy again in most cases. "Professional cleaning can jump-start the treatment and get you back to square one," he says. "Then [gingivitis] shouldn't come back."

But if the gums worsen and infection eats away at the bones, McGuire says, the condition has to be treated more aggressively and might require a deep cleaning - called root planing and scaling - to dig into pockets of bacteria that can't be reached by a toothbrush or dental floss. Or surgery might be needed to open gums, clean out infection and graft new bone into place.

Smoking is the top risk factor for gingivitis and serious gum disease, or periodontitis, McGuire says, noting that smokers are four times more likely than nonsmokers to have these problems. Also, he notes that some people seem predisposed to gum disease and must work harder to maintain a healthy mouth.

According to McGuire, studies have found that people with severe gum disease are at increased risk for heart disease, diabetes, stroke and low birth-weight babies. He notes that hormonal changes can alter a body's response to bacteria; to avoid gum disease during pregnancy he suggests women get a professional cleaning every three months, roughly the time it takes bacteria to produce toxins that can damage gums.

Family physician Bruce Bagley, of Albany, N.Y., says a general checkup includes a look in a patient's mouth. If he sees redness-a sign of infection-where the teeth meet the gums, he treats his patient with antibiotics and refers him to a dentist. "Waiting for bleeding gums [before diagnosing gum disease] is like waiting until you're 400 pounds to diagnose obesity," he says.

While studies have shown that electric toothbrushes are effective at improving dental health, McGuire says a person with good manual dexterity can "do just as well" with a hand brush and floss. He suggests starting with a professional cleaning and learning proper brushing and flossing techniques.

If infected gums remain a problem, a person might try "anti-plaque" toothpastes and other dental products that are available over-the-counter. More potent are "antigingivitis" products, which must meet a higher federal standard to justify their claim of decreasing the risk of developing gum disease. Among these is Colgate Total, approved by the Food and Drug Administration (FDA) in 1997 as the first toothpaste shown to reduce gum disease. Total with an active ingredient called trielsan was found to perform significantly better than standard fluoride toothpaste in helping to prevent plaque and gingivitis in adults.

Toothpaste and mouth rinses primarily freshen breath and provide fluoride to help prevent tooth decay. Yet standard fluoride toothpaste also have ingredients that make it easier for the body to fight plaque, while rinses, such as Listerine, have antiseptic ingredients that help kill off bacteria. If over-the-counter products aren't doing the job, then FDA-approved rinses, such as antibacterial chlorhexidine, are available by prescription.

Marjorie Jeffcoat, who chairs the department of periodontics at the University of Alabama, School of Dentistry in Birmingham, says it's important to ask a dentist or dental hygienist what's best for you. An elderly woman with rheumatoid arthritis, for example, may have trouble flossing; tools such as tiny brushes and rubber picks can allow her to maneuver more easily between teeth and gums.

Jeffcoat stresses the need for prompt treatment, noting that her research has found that woman with chronic gum disease are three to eight times as likely to deliver a low- birth-weight baby as a woman with healthy gums.

For overall dental health and the avoidance of gum disease most experts agree on the importance of a diet rich in calcium and vitamins and low in processed sugars.

Natural Solutions

For people interested in trying natural products to keep gums healthy, several herbs have been incorporated into commercial anti-plaque toothpaste and mouthwash, where they act mainly to prevent bacteria from turning into plaque. Results from studies testing products containing bloodroot, or sanguinaria, have been mixed, while researchers continue to study products from the neem tree, widely used in India to prevent gum disease.

Lawrence E. Wolinsky, professor of oral biology and oral medicine at the UCLA School of Dentistry, has spent 20 years trying to isolate and identify natural anti-plaque agents. He says results from his work on Nigerian chewing sticks; neem and other bioflavinoid-containing plant extracts, while not definitive, are encouraging as to clinical effectiveness. But he says more research is needed; for example, to determine whether neem is being sold in the best concentrations and formulations.

A recent laboratory study by Wolinsky found that a test toothpaste containing green-tea bioflavinoids significantly reduced dental plaque compared with a placebo toothpaste. He says the test toothpaste and Viadent, a commercial toothpaste with bloodroot, performed well (though not as effectively) compared with triclosan, which he calls "the gold standard" for OTC plaque control.

Jeffcoat and McGuire don't suggest herbal products to their patients: "Why spend anything extra when you can do without it?" McGuire asks. Yet they say if taking natural product gives people a positive outlook on dental health and doesn't harm them they're all for it.

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