Question

Your patient is a 12 year old male, who in spite of good oral hygiene practices, presents with generalized marginal redness and bleeding upon probing. His demonstration of tooth brushing and flossing indicate high dexterity and ability to remove plaque biofilm and in talking with his mother, she confirms that he practices daily oral hygiene. How would you explain the presence of gingival disease to this patient and what would you recommend to improve his gingival health?

Answer 1

Gingival diseases are the mildest form of periodontal diseases of which plaque-induced gingivitis is most common. Clinically it is characterized by gingiva which is red,swollen and bleeds easily. Some patients may brush and floss regularly, but their gums will still bleed when stimulated. The reason is that the equilibrium that exist between dental plaque bacteria and the host defense system is disturbed. When the host immune system is weakened gum bleeding could occur. Immune system is weakened by various factors such as, presence of some medical conditions ,unhealthy diet, or lifestyle choices. Other factors responsible for gingivitis include,hormonal imbalances (as per American Academy of Periodontology, increased progesterone and estrogen leads to an increase in blood flow to the gums, making them more sensitive.), Stress (including physical, metabolic, emotional and psychosocial), Vitamin deficiency, side effects of medications such as, Fluoxetine , Calcium channel blocking drugs (Flunarizine),  Sertraline (Zoloft), Phenytoin (Dilantin).

Brushing and flossing alone generally are not sufficient to remove all plaque from the gumline. Hence plaque will accumulate to the extent that it can cause gum disease. This is why dentists recommend that their patients have cleanings and checkups every six months.

Bleeding gums are a warning sign of the imbalances in the body. The key is to restore balance with appropriate rest, sleep, diet, and exercise to manage both physical and emotional stress. The first line of defense is to mechanically remove the bacterial plaque by daily brushing and flossing plus regular 6 month check-ups with dentist. Advice patient to have plenty of calcium-rich foods such as milk, yogurt, and cheese. Calcium maintains the bone the tooth roots are embedded in. This is particularly important for older adults and for children during development of both baby and adult teeth. Also consumption of food rich in sugars increase bacteria and plaque around the tooth so it s better to reduce consumption of such foods. Avoid taking soft candies , pastries, toffees. chewing sugar free gums. Discontinuation of any offending medication.