What is the difference between gingivitis and periodontitis, their causes, treatment, and prevention

doctor with stethoscope, artgraphics

zaidharis

One might think the answer to “what is the difference between gingivitis and periodontitis” is the same but there is a difference between these two diseases. These diseases i.e Gingivitis and periodontitis are real headaches for people but this can be stopped before it is got. Here in this article, I am giving a detailed description of gingivitis, periodontitis, its causes, effects, and treatment. After reading this article you will have no confusion about these two diseases. And for prevention or treatment check out the Top 10 best toothpaste for gingivitis and bleeding gums.

These diseases start with teeth and gums so let’s start with explaining the structure of teeth and gums.

what are teeth?

Teeth can be defined as:

“Hard calcified projection from gums used for mastication of food and offense and defense purpose in humans as well as in many vertebrates.”

The term “gum” what is meant by this?

Well, wait please first we should go for the teeth structure and then we will come to the gums.

Did you look at yourself smiling in the mirror?

Yes, there is nobody who has not seen their tooth except blinds.

What have you seen?

A white hard part and the soft part where tooth projects.

Well, the teeth have three parts.

I) Crown:

The white and visible part you see is the crown.

The Crown is made up of a white hard layer called enamel. Enamel is the hardest part of the body.

Why enamel is so hard?


Good question, Because it is made up of mineral material (96%) non-living tissue i.e hydroxyapatite and water 2 to 3%
. Hydroxyapatite is crystalline calcium phosphate, So take care of your teeth because it cannot be built up naturally.

I think you are clear now about enamel?

Yes, pretty clear.

Below the enamel, there is another layer called dentin. It forms the bulk of teeth. But it is not hard as enamel is.

Pulp:

The soft part of dentin is called the pulp. Here blood vessels and nerves reside.

So what is the function of pulp then?

It has:

  • Sensory function

Did you feel pain in your teeth?

Yes.

And did you detect the temperature and pressure change by your teeth?

Yes. That’s the pulp that detects these changes.

  • Dentin formation

    The pulp is the structure that forms dentin.

  • Nourishment

    Finally, teeth also need nourishment and moisturization which blood vessels in pulp provides.

Is the teeth’ color related to enamel or dentin?

It depends on both enamel and dentin.

How?


Firstly the teeth’ color is determined by dentine which tends to be yellowish and then by the enamel translucency.

If the enamel is more translucent then more light will pass through the enamel reflecting the purer color of dentin.

The less translucent, the more light will reflect by enamel and will show whiter color.

But we didn’t hear about Root?

You said I came, Root is that part of teeth that is invisible and embedded in gums (explained later in this article).

Can you please tell us the function of the root?

Of course, roots anchor the teeth inside the bone.

Have you heard about the alveolar process?

No.

Don’t worry, I am making it clear here.

The alveolar process is a thickened ridge on the jaw bone that contains the socket to hold teeth. And these bones are the maxilla (upper jaw bone ) and mandible (lower jaw bone) and you know teeth are present on these bones.

Now I am sure that you are clear about teeth structure!

Yes, pretty clear.

Between these, there is one more structure i.e Neck of the teeth.

II) Neck:

Between crown and root, there is a part called the neck of the teeth which joins or connects the crown with the root.

Now come to your question gums?

III) Gums:

It is also called gingiva or gingivae (plural). The pink, fleshy, mucosal tissue surrounds the neck of teeth and covers the alveolar part (mandible and maxilla) of the jaw.

Are there any types of gums?

Yes, there are three types of gums.

i) Marginal gum

ii) Attached gum

iii) Interdental gum

Let’s explain one by one.

i) Marginal gum

As the name indicates it is present in the margin at the neck of the teeth in a collar-like fashion. Their width varies from 0.5 to 2.0 mm.

ii) Attached gum

Below marginal gum, there is attached gum but it is continuous with marginal gum. Their width varies with the location. Generally, it is greater in the incisor region i.e 3.5mm to 4.5mm in the maxilla (upper jaw bone) and 3.3mm to 3.9mm in the mandible (lower jaw bone).

But their width decrease in the posterior premolar region of the mouth and it ranges 1.9mm in the maxilla and 1.9mm in the mandible.

iii) Interdental gum

The gum between two teeth is called interdental gum.

There is two more part of gingiva or gum which I want to explain because it is necessary to understand.

Free gingiva (gum)

The part of gum which is sticks up and is not anchored to the teeth is called free gingiva.

Gingiva crevice/sulcus

This is the space between the free gingiva and the crown of the teeth.

Are there any signs through which we can identify that our gums are healthy?

Yes, I am giving you some of the signs of your healthy gums.

i) Color

Is your gum color pink, not red or white, not swollen or tender, and limited sensibility to pain, temperature, and pressure?

If yes, then you are lucky you have healthy gums unless you have no other mouth issues.

ii) Counter or shape

Healthy gums have a smooth and scalloped appearance around each tooth. It fills the space between teeth, unlike gingivitis papillae in which swollen gum papillae fill the space.

iii) Texture

Healthy gums also have a firm texture and often exhibit surface stipplings

iv) Reaction to disturbance

Healthy gums do not show any reaction to common disturbances like brushing or periodontal probing, unlike unhealthy gums that show bleeding, etc.

Clear?

Yes, pretty clear.

Did we move to the next part, gingivitis?

Of course, This is going more interesting.

Okay, let’s dive into it.

Gingivitis

The inflammation of the gums is called gingivitis.

Just that?

No, there is a lot to tell about this.

Before going further, let’s explain their types.

I) Drug-induced gingivitis

Certain medications cause the overgrowth of gum tissue known as gingival hyperplasia. The common drugs which do this are immunosuppressants, some calcium channel blockers like Verapamil or Nifedipine, and anticonvulsants.

What are these drugs?

Here I am giving you a short info about these drugs.

a) Immunosuppressants:

These drugs are anti-rejection drugs. It means it is used to reduce the body’s response to reject the transplanted organ.

b) calcium channel blockers:

Calcium channel blockers are drugs like Verapamil or Nifedipine which are used to dilate blood vessels and increase the blood flow and oxygen to the heart reducing the workload.

c) Anticonvulsants:

These drugs are used in the treatment of epileptic seizures (A sudden uncontrollable electrical disturbance in the brain, A neurological disorder) and are also known as antiepileptic drugs or as antiseizure drugs.

So it means if you are using these drugs you can also get gingivitis. To treat this condition just you need to control medication and consult your dentist.

II) Hormonal Gingivitis

Hormonal gingivitis is more common in females than males because they have more hormonal changes during puberty, and pregnancy, and using pregnancy birth control pills which change the level of progesterone which increases blood flow to gums and changes the way gum reacts to an irritant in the plaque, causing gingivitis.

III) Nutritional gingivitis

Nutrition is important for not only the gums but also for the whole body. Severe nutrition deficiency can cause the pallor of the gingiva (gums) and heavy bleeding. Controlling nutrients can stop gingivitis.

IV) Plaque induced gingivitis

This is the most common type of mild gum disease and as their name shows, gingivitis due to plaque buildup in the gums or gingiva. The oral unhygienic condition leads bacteria to grow and causes them to red, tender, and bleed.

V) Non-plaque induced gingival lesions

As the name indicates this type of gingivitis is due to microorganisms like bacteria, fungi, viruses, etc. Treatment is using a mouthwash or consulting your dentist is the best solution.

VI) Acute Necrotizing Ulcerative

This is also known as trench mouth and is a highly painful form of gingivitis as there are sensitive ulcers between the gum between teeth. This terrible gingivitis is less common than others but the tissue in the gums appears punched out.

Acute necrotizing condition results due to elevated immune response lymph node inflammation.

Signs and Symptoms:

  • Redness
  • Swollen or puffy gums
  • Bleeding after brush
  • Receding gums
  • Tender gums

Do you know there is a lot of bacteria in our mouth?

Yes.

And do you know why this bacteria didn’t cause damage to gums and teeth?

Little, okay listen, there is a balance of commensal bacteria by immune factors and competition between each other.

Then why does someone get gingivitis?

Dysbiosis.

What is this?

A state of imbalance of bacteria in which pathogenic bacteria increases due to lack of competition by commensal bacteria or by the ineffective immune response.

How do they imbalance?

The pathogenic bacteria form dental plaque which is a sticky collection of bacteria, saliva protein, and dead cells of the mouth and increase their number.

How?

The individual bacteria multiply and form small microcolonies and form a layer of dental plaque or in other words a biofilm in which bacteria and biofilm communicate with each other through chemical signaling.

So does brushing teeth didn’t remove it?

Well, Brushing remove that biofilm on the exposed part of teeth and gums, but some remain in the inner gingiva or gum and invade the inner gums.

And what do they do then?

Damage, as this is their job, the dental plaque then forms a hard mass called dental calculus or tartar. Dental calculus provides a nice space for the bacteria because it is hard and it becomes very difficult to remove it.

This is alarming!

Yes.

Is that gonna damage more or stop here?

No, this does not stop until these bacteria satisfy themselves by entering through the gingiva sulcus and causing inflammation which we actually call gingivitis.

But where was that immune system at that time?

They need signals to work, and since damaged gingival cells release inflammatory signals which recruit neutrophils to the damaged area. The neutrophils release harmful chemicals to kill bacteria but these chemicals also damage the nearby tissue.

That’s why you are brushing your teeth or just touching your gums it starts bleeding.

Now, you understand gingivitis completely, let’s go to their types.

But I have seen some people who take much care of their teeth but still, their gums or gingiva bleeds?

Good question, one of the examinations in patients says that is due to a deficiency of Vitamin D, so if you have this condition then take a high dose of vitamin D and your problem will resolve as it was resolved in patients.

Women in pregnancy have bleeding gums because

During pregnancy, some women’s gums bleed that’s is also plaque induces gingivitis, which is due to a hormonal imbalance in which blood flow to the gingiva or gums increases and causes it to be more sensitive, irritable, and swollen.

Also, this hormonal imbalance affects the body’s normal response to the bacteria which can lead to severe conditions.

So how much time a pregnant woman has to bear this problem.

After stopping breastfeeding the hormonal level return to the normal level stopping more problems with teeth.

Then how can a pregnant woman or up to breastfeeding, have to care for their gums?

Frequent dental cleaning in pregnancy can abate this problem.

Is it reversible to get healthy gums after stopping this disease?

The answer is yes if treated earlier but if conditions got worse then it will lead to an infection called periodontitis.

Periodontitis

The word periodontitis means inflammation around teeth and it is also called pyorrhea which is a Greek word that means “discharge of pus“.

The Pyorrhea/Periodontitis definition is:

“The severe form of gingivitis is in which the gum pulls away from teeth, destroys attachment fibers, and supporting bone that holds the teeth.”

If not treated the ultimate result is the loss of teeth.

When will this condition arise?

When dysbiosis increases more and even more pathogenic bacteria flourish in the mouth. One hypothesis says that the first step in periodontitis formation is the formation of the orange complex of bacteria.

“Orange complex bacteria”
what is it?

The orange complex bacteria serve as a “species bridge” for the early colonizers with highly pathogenic bacteria of the red complex.

Could you please tell us the name of orange complex bacteria and also explain what is red-complex bacteria?

Yes, of course, the orange complex bacteria are gram-negative, anaerobic (can respire in the absence of oxygen) bacteria namely FUSOBACTERIUM NUCLEATUM and PREVOTELLA INTERMEDIA.

Now coming to red-complex bacteria.

Red complex bacteria

These bacteria are highly pathogenic which causes periodontitis. It includes TANNERELLA FORSYTHIA, TREPONEMA denticola, and the most notorious one the PORPHYROMONAS gingivalis.

How does it swell the gingiva which bleeds?

Well, the pathogenic bacteria form a periodontal pocket with the pre-dental plaque. Local mast cell release and nerves trigger the release of histamine which dilates the blood resulting in swelling of the gingiva or gum.

And how lead to tooth loss then?

The damaged gingiva cells release additional cytokines like interleukin-1 which bring more immune cells i.e neutrophils and macrophages. Ultimate results are again damaging to the gingiva and periodontal ligaments which loosen the tooth.

I want more about PORPHYROMONAS GINGIVALIS?

This bacteria is really a damaging bacteria to the gingiva. These bacteria impair immune cells.

Impair immune cells, Kind of shocking, how?

Consider a police station, if the police station of an area is destroyed or controlled by thieves then you should think about the rule of thieves in that area. Similar is the case here, the P.gingivalis destroys or impairs the immune cells and forces other pathogenic bacteria to cause damage.

And how do they get the nutrients?

The immune response delivers more blood flow to the damaged gingiva cells and certainly more nutrients, on which bacteria feed forming a positive feedback process. The positive feedback mechanism instead of stopping increases more and delivers more blood and nutrients, helping more pathogenic bacteria to grow.

It is not the end of the immune system response. The immune response activates the osteoclasts (bone cells) in the bone which dissolve the bone supporting the teeth and even loosen teeth more.

So what is the main cause of this infection and also what are the risk factors?

Generally, the main cause is bacteria but smoking, diabetes, HIV, or AIDS are risk factors that contribute to this disease.

How can someone know that they have periodontitis?

Symptoms are the same as gingivitis but there some additional signs to detect periodontitis which are.

  • Pain or discomfort in the gums.
  • Teeth loosening, increase sensitivity, and soreness.

I am confused, could you please tell us the difference between gingivitis and periodontitis?

As already you know about gingivitis, let’s me explain more about when it leads to periodontitis.

Comparison of gingivitis vs periodontitis:

  • The main difference is that gingivitis is reversible while periodontitis is not reversible because of teeth bone loss which cannot be recovered.
  • If you are feeling pain while chewing then you think that gingivitis has progressed to periodontitis.
  • Are your gums are red, swollen, or irritated though your teeth are firmed in place, If yes, then you have gingivitis but if there is tooth loss or inner damage then it is progressed to periodontitis.
  • Bad breath is a sign of periodontitis because of excessive bacteria growth in the mouth.

How can we prevent this before it appears in the mouth?

Well, I would suggest the following precautions that everyone should follow to be safe from these diseases.

  • Brush your teeth at least twice a day after a meal which is the best time for cleaning teeth and gums because bacteria feed on food particles after the meal and grow.
  • Stop smoking, smokers have more chance to get the periodontal disease than non-smokers, also it reduces the success of treatment.
  • Use a soft or extra-soft bristled toothbrush.
  • Choose an electric toothbrush for maximum cleaning results.
  • Reverse periodontal disease by using a natural mouthwash.
  • Decrease your stress because in stress body’s immune doesn’t respond very well.
  • Take a well-balanced diet that helps your immune system to fight infections. Antioxidant properties of food like vitamin C (Citrus fruits, vegetables, fruit like strawberries, etc) or vitamin E (Nuts, almond, vegetable oil, soya bean oil, etc) can help to repair damaged body tissues and for gums regrowth.
  • Limit sugar.
  • Visit at least once a year to your dentist.

And after it appears what have to do then?

You must consult your dentist in order to avoid more damage. They will check the deepness of the plaque by a special probe called dental armamentarium and will remove it.

Could you please recommend to us the best toothpaste for preventing bleeding gums and gingivitis?

I recommend you the following toothpaste for bleeding gums but check out this list of “Top 8 best toothpaste for gingivitis and bleeding gums”.

Conclusion/Summary

The conclusion is that the answer to the question “what is the difference between gingivitis and periodontitis” is that Gingivitis is the inflammation of the gums while periodontitis is the severe form of gingivitis is in which the gum pulls away from teeth, destroys attachment fibers, and supporting bone that holds the teeth. The care of the teeth and gums is very necessary by choosing the best toothpaste or by oral hygiene.

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