diease

Gingival Bleeding


OVERVIEW OF Gingival Bleeding :

      Inflammation of the gingiva due to several provoking factors results in gingivitis and bleeding gums.The bleeding gums might reveals the underlying periodontal disease origin.


STRUCTURE of Gingival Bleeding :

The gingiva is  a resilient structure which covers the bony surface of the root . It is normally stippled in appearance. The colour of the gingiva ranges from coral pink to heavily pigmnented. The gingiva provides the protective action to the underlying tooth structures. The gingiva is divided in to free gingiva,attached gingiva,alveolar mucosa and muco gingival junction and interdental gingiva. Pathophysiology:

  • Gingivitis usually originates from the bacterial plaque that accumulates in the spaces between the gums and the teeth, and visible calculus (tartar) formed on the teeth.
  • When the teeth are not adequately cleaned by regular brushing and flossing .The plaque accumulates, and gets mineralized by calcium and other minerals in the saliva which transform them into a hard material called calculus harboring bacteria and irritating the gingiva.


CAUSES :

 Plaque deposition around the tooth structure. Plaque is an deposits that contains bacteria in plugs and other minerals such as calcium,phosphates and metaloproteinases bind together and it is easily get deposited in the tooth surface.

Improper oral hygiene

Overzealous brushing

Smoking

Anysystemic manifestations which includes diabeted mellitus,leukaemia.

Vitamin deficiency

Loss of clotting factors

Thrombocytopenia

Pregnancy-hormonal changes

Food impaction

Haemophilia

Malnutrition

Intake of medications such as Aspirin


PATHOPHYSIOLOGY :

  • Gingivitis usually originates from the bacterial plaque that accumulates in the spaces between the gums and the teeth, and visible calculus (tartar) formed on the teeth.
  • When the teeth are not adequately cleaned by regular brushing and flossing .The plaque accumulates, and gets mineralized by calcium and other minerals in the saliva which transform them into a hard material called calculus harboring bacteria and irritating the gingiva.
  • As the bacterial plaque biofilm becomes thicker, an anoxygenic environment develops which allows more pathogenic bacteria to flourish and release toxins and initiates gingival inflammation.
  • Alternatively, excessive injury to the gums caused by very vigorous brushing may further lead to a cycle of recession, inflammation and infection.
  • The superseded infection usually begins when the immune system of the body gets weakened due to some local or systemic conditions.
  • Over the years, this inflammation and infection can cause deep pockets between the teeth and gums, and subsequent bone loss around the teeth thereby resulting in a periodontitis
  • The inflammatory reaction leads to the release of different inflammatory mediators which results in vasodilatation of the vessels and this leads to increase in blood flow to the gingiva and bleeding occurs.

Local factors

  • Crowding of teeth makes the plaque difficult to remove completely.
  • Malaligned teeth which often require orthodontic correction further adds on to the difficulty in cleansing.
  • A dental prosthesis that is inadequately fitted or improperly finished can act as a nidus for the plaque accumulation.
  • Eruptive gingivitis: In children, tooth eruption is also frequently associated with gingivitis, as plaque accumulation tends to increase in the area where primary teeth are exfoliating, and moreover, an oral hygiene is difficult to be maintained in the areas where permanent teeth are erupting.

Infectious gingivitis 

  • A low-grade injury to the local tissues such as fractured teeth, overhanging restorations, overextended flanges of the denture, and faulty fixed dental prosthesis with poor pontic design (saddle pontic) or over contoured margins act as a predisposing factor to it.

Hypersensitive reaction 

  • An allergens in the form of chewing gum, toothpaste, cinnamon, mint, red pepper, etc. can trigger the plasma cells infiltration in the gingiva, and causes plasma cell gingivitis.

Nutritional gingivitis

  • Dietary habits with a higher intake of refined carbohydrates and an increased ratio of omega-6 to omega-3 fatty acids can initiate the inflammatory process through activation of NFkB and oxidative stress. 

Hormonal gingivitis

  • This form of gingivitis occurs during pregnancy,puberty or steroid therapy even without the presence of plaque.
  • Pregnancy: An increase in the circulating female sex hormones causes pregnancy gingivitis. 
  • Puberty: During adolescence, gingivitis observed to appear earlier in girls (eleven to thirteen years) in comparison to boys (thirteen to fourteen years). 

It has been found that the receptors in the cytoplasm of the gingival cells have a high affinity for both estrogens and testosterone. The receptors for estrogen are specifically present in the basal and spinous layers of the epithelium; whereas in the connective tissue, such receptors are found deeper in the fibroblasts and endothelial cells of small vessels. Hence, the gingiva is considered as an easy target organ for these steroid hormones resulting in bleeding.

The etiologic factors provoke the inflammatory reaction in gingiva and vasodilation occurs which results in bleeding of gingiva due to overflow of blood to the gingiva.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Pain while brushing the teeth

Bleeding

Pain at the gums region

Exposed the root

Loosening of teeth

Red swollen gums

Mal odour

Receding gumline


DIAGNOSTIC :

Spontaneous bleeding on probing: 

     A probe which is called William probe is placed in the gingiva which results in bleeding

Blood test:

Blood count:

 Total blood count such as RBC ,WBC, platelet  are tested.

Clotting factor deficiency should be monitored

Pocket evaluation:

Assessment of pocket (the gap seen  between the tooth surface and gums due to deattachment of gingiva from underlying structure)

Anatomical changes in the gingiva.


TREATMENT AND PROGNOSIS :

Causative factor of the disease should be under control

Dentist might recommend for the procedures such as scaling,root planning.

Scaling: the dentist or dental hygienist cleans the tooth surface with an ultrasonic instruments and wait for the prognosis.

Root palnning: root planning involves minor surgical procedure and it is done under local anaesthesia. The dentist expose the root surface by elevating the gum layer and cleans those surfaces.

Flap surgery:

Flap surgeries are needed when critical conditions are indicated.

Medications:

Augmentin( a combination of amoxicillin  and clavulanic acid provides a major role in controlling the disease)

Doxycycline- 10mg

Ibuprofen or paracetomol can be administered for pain relief


PROGNOSIS :

The prognosis mainly depends upon the gingival health.Atleast it takes 3-8 weeks for the gingival infection to subside.


PREVENTION :

Brush the teeth : brush the teeth twice daily to prevent from food and debris accumulation in the teeth surfaces.Clean the surface of the tongue since debris debris accumulation is moFre in it.

Flossing: Flossing the teeth helps in eradication of the debris and plaque.

Swish with the mouth wash: using the mouth on regular use helps in reducing the bacterial load.

Take lots of fiber food as it helps in swishing away the bacteria

Always gargle with normal tap water after taking the food.


Medicines used in the Treatment :

Augmentin( a combination of amoxicillin  and clavulanic acid provides a major role in controlling the disease)

Doxycycline- 10mg


REFERENCE :

http://healthline.in

http://cdc.in

http://periodontology.in

http://medicinenews.in