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Smoking and Gum Disease

The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.

Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.

Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.

Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.

The use of tobacco products can increase the risk of periodontal disease:

1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.

2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.

3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.

4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.

Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.

Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.

By Laura Minsk, DMD

Gingivitis - Everything You Need To Know

Gingivitis is the most common periodontal disease, affecting 90% of the population. It is an infection of the gums caused by bacteria that form plaque.

In small amounts (when it is newly formed), plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume and the proportion of harmful bacteria grows. These gingivitis bacteria release toxins that result in inflammation of the gum tissue and bad breath.

Eventually, the plaque hardens and forms hard deposits called calculus or tartar. If not properly treated, gingivitis may progress to periodontitis, a periodontal disease in which there is loss of the bone that supports the teeth.

Signs of Gingivitis

Gingivitis can be identified by red or swollen gums. In some circumstances, the gingivitis can cause bleeding gums when brushing or eating, and there may be bad breath. To diagnose gingivitis, a dentist may probe gently under the gums. In healthy gums, there should not be any bleeding with this gentle probing. A bleeding gum indicates that there is gum inflammation or gingivitis.

Who's At Risk for Gingivitis?

Certain people are more susceptible to gingivitis. Stress, smoking and poor nutrition can contribute to the development of gingivitis. Certain medications such as steroids, heart medications, cancer therapy drugs, anti-epilepsy drugs, and anti-depressants also increase the risk for gingivitis.

In the presence of plaque, these medications can lead to gum overgrowth. The enlarged gums can further interfere with oral hygiene, precipitating a vicious cycle of further gum enlargement.

Changes in female hormones can also increase the vulnerability to gingivitis. Adolescent women, pregnant women and women who take hormone replacement or birth control pills also have a greater risk of developing gingivitis.

There are several systemic illnesses that are associated with gingivitis. These include

• acute leukemia
• Addison's disease
• diabetes
• hemophilia
• immunodeficiency diseases (including HIV)

The swelling and redness of the gums may be disproportional to the amount of plaque present. To prevent further complications, meticulous plaque control is critical for people with these illnesses.

Gingivitis Treatment

For gingivitis treatment, the bacterial plaque and tartar have to be removed from the surfaces of the teeth by a dentist or hygienist. Then, the factors that contribute to plaque retention have to be altered in order to facilitate oral hygiene procedures.

This can involve re-shaping existing restorations or even moving teeth with braces so that they are not crowded. Essential to the success of the gingivitis treatment is the person's ability to control plaque build-up after initial treatment. Daily brushing and flossing are key to gingivitis prevention and helps prevent bad breath.

If there is a lot of gum inflammation, if the gums are very sensitive, or if there is a lot of tartar buildup, it may be necessary to numb the gums in order to remove the buildup of bacteria underneath the gum margins. If the gum is very inflamed and swollen, it may be necessary to remove some of the excess gum tissue surgically.

Gingivitis is reversible, and with proper gingivitis treatment and maintenance, it can be controlled. However, untreated gingivitis can result in gum defects, bone loss around the teeth, and eventual tooth loss and systemic complications. The best way to prevent gingivitis is by brushing and flossing daily, and by visiting the dentist for a routine cleaning and an examination at least every six months.

By Laura Minsk, DMD