Your Gums

Your Gums (Gingiva)

The Gingiva represent the tissue area around the root section of a tooth. The gingiva a very tenacious, insoluble protein membrane that surrounds the teeth. It forms a band around each tooth that ranges in width from1 to 9 mm. The gingiva is attached in part to the cementum of the tooth and in part to the alveolar bone. The gingival (or alveolar) mucosa is the darker colored mucosa, which is found in the deeper sections of the jaw. This mucosa is movable, but it is designed for the rigors of chewing.

In light-skinned individuals the gingiva can be readily distinguished from the adjacent dark red gingival mucosa by its lighter pink color.

In dark-skinned people the gingiva may contain melanin pigment to a greater extent than the nearby alveolar mucosa. This melanin pigment is synthesized in specialized cells and is produced as granules that are stored within the cells that produce melanin. If pigmented gingiva is surgically inspected, it will often heal with little or no pigmentation. Therefore, surgical procedures need to be designed so as to preserve the pigmented tissues. Clinicians sometime use the terms free and attached gingiva. Attached gingiva refers to the portion of the gingiva towards the top of the tooth. Free gingiva is firmly bound to the underlying tooth and alveolar bone.

The area of the gingiva near the crown of the tooth (Gingival margin) in young people is more likely to become exposed as a result of tooth eruption.

The gingiva occupies the spaces between teeth. It is composed of a pyramidal papilla in the incisor region. The gingiva is attached to the tooth by an epithelium and by connective tissue fibers at the top.

Gum Diseases

As we get older, gum diseases can become very common. On most occasions, gum diseases can be traced back to ineffective or improper oral hygiene procedures. The mildest form of gum disease is Gingivitis.

A. Gingivitis

Gingivitis - an inflammation of the gums - is the initial stage of gum disease and the easiest to treat. The direct cause of gingivitis is plaque - the soft, sticky, colorless film of bacteria that forms constantly on the teeth and gums.

If the plaque is not removed by daily brushing and flossing, it produces toxins (poisons) that can irritate the gum tissue, causing gingivitis. At this early stage in gum disease, damage can be reversed, since the bone and connective tissue that hold the teeth in place are not yet affected. Left untreated, however, gingivitis can become Periodontitis and cause permanent damage to your teeth and jaw.

Treatment consists of a professional cleaning by a dentist or hygienist, followed up by a rigorous home care program that emphasizes proper daily plaque removal by mechanical means (floss & toothbrush).

To the left you can see a picture of teeth that have some red inflammation at the gingival margin (blue arrows). This is a classic sign of gingivitis. The cause for this is usually a constant accumulation of plaque and calculus.

B. Periodontitis

Periodonditis is a dental disorder that results from progression of gingivitis, involving inflammation and infection of the ligaments and bones that support the teeth.

Periodontitis occurs when inflammation (gingivitis) or infection of the gums is untreated or treatment is delayed. Infection and inflammation spreads from the gums (gingiva) to the ligaments and bone that support the teeth. Loss of support causes the teeth to become loose and eventually fall out. Periodontitis is the primary cause of tooth loss in adults. This disorder is uncommon in childhood but increases during adolescence.

Plaque and tartar accumulate at the base of the teeth. Inflammation causes a pocket to develop between the gums and the teeth, which fills with plaque and tartar. Soft tissue swelling traps the plaque in the pocket. Continued inflammation eventually causes destruction of the tissues and bone surrounding the tooth. Because plaque contains bacteria, infection is likely and a tooth abscess may also develop, which increases the rate of bone destruction.

Examination of the mouth and teeth by the dentist shows soft, swollen, red-purple gingiva. Deposits of plaque and calculus may be visible at the base of the teeth, with enlarged pockets in the gums. The gums are usually painless or mildly tender, unless a tooth abscess is also present. Teeth may be loose and gums may be receded. X-rays reveal the loss of supporting bone and may also show the presence of plaque deposits under the gums.

The goal of treatment is to reduce inflammation, eliminate pockets if present, and address any underlying causes. Dental irritants, such as rough surfaces of teeth or dental appliances, should be repaired. General illness or other conditions should be treated.

It is important to have the teeth cleaned thoroughly. This may involve use of various instruments or devices to loosen and remove deposits from the teeth (scaling) and to smoothen the root surfaces again (planning). The dental procedure for this type of treatment is therefore called a Scaling and Root Planning Procedure. Meticulous home oral hygiene is necessary after professional tooth cleaning to limit further destruction. The dentist or hygienist will demonstrate brushing and flossing techniques. With periodontitis, professional tooth cleaning is often recommended more frequently than the standard twice a year.

Surgical treatment may be necessary. Deep pockets may need to be opened and cleaned. Loose teeth may need to be supported. Extraction (removal) of a tooth may be necessary for advanced periodontitis so destruction doesn't spread to adjacent teeth.

The left image shows moderate case of adult periodontitis. Notice that the gingiva has migrated down the teeth somewhat, making them appear longer. This, of course has an equivalent degree of attachment loss as a consequence.

This image to the left shows an advanced degree of adult periodontitis. Notice the dramatic increase in attachment loss as compared to the image above. At this point moderate to severe mobility of the tooth has to be expected.