Gingivitis is an inflammatory gum disease caused by infection of the gums due to poor oral hygiene, infection, injury, poor micro-circulation or chronic stress. The condition is painless and therefore causes little initial concern; however, the gums are usually swollen, tender and bleed. The breath may smell bad due to oral dysbiosis. An early marker is the enzyme salivary lactate dehydrogenase, which is elevated when tissue breaks down.

Signs and symptoms may also include dry mouth, difficulty swallowing, aphthous ulcers, and jaw disorders (TMJ). The immune system is also evidently disturbed due to micro-organism or their toxic metabolites breaching the ‘blood-saliva barrier’ and enter the systemic circulation. Auto-immune diseases have a strong association to oral disease such as rheumatic diseases, Crohn’s disease, Sjogren’s, lichen planus, ulcerative colitis, and systemic lupus erythematosus, conditions that show altered immune regulation. The problem is bi-directional with diabetes, lung disease, obesity, osteoporosis, liver disease and atherosclerosis being related to periodontal disease.

An adverse alteration of micro-organisms in the mouth is called oral dysbiosis. Commensal micro-organisms normally play a significant role in maintaining oral health by controlling an inhibiting the colonisation of the gums (gingiva) and oral mucosae by pathogens. Strains of friendly bacteria such as Streptococcus sanguinis are able to encode peptides that can defensively bind various cell and bacterial receptors; however this protective mechanism is disrupted when conditions change and pathogenic species such as Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia proliferate.

The usual cause of gingivitis is a chronic low-grade infection due to the formation of plaque on the tooth surface caused by snacking on carbohydrate-rich foods without regular brushing. Other causes are inadequate nutrition, smoking, diabetes, poor immunity, infection and chronic stress. Plaque is comprised of a microbial biofilm which harbours colonies of micro-organisms that secrete inflammatory mediators, toxins, enzymes, and acids onto the surface of the gums and teeth.

As the plaque thickens and hardens it shelters the colony and allows them to proliferate, while a hard calculus precipitates from minerals in the saliva and gingival fluid. The calculus (tartar) is comprised mostly of calcium phosphate and hydroxyapatite, and a dense matrix (proteins, lipids, glyco-lipids and DNA).

The hard calculus further irritates and inflames the gum, leading to a loss of collagen between the gum and teeth, causing recession of the infected gums. The receding gums eventually form deep pockets where food collects and anaerobic micro-organism proliferate, further shielded from brushing, and the teeth become elongated and decay (periodontitis). In more serious cases there is bone erosion in the jaw leaving the teeth unsupported so that they become loose and have to be extracted.

Inflammatory fibrous nodules are also common on the gum surface, while bony exostosis, cysts, vascular epulis, giant cell granuloma, ligneous gingivitis, verruciform xanthoma are less common. The risk of any lump or growth being malignant means that they should be checked when found.

Treatment

General

Calculus formation is normal so teeth must be brushed and flossed after meals and de-scaled by a dentist about every six months. Smoking adversely affects oral health by causing dysbiosis and oxidative stress to the gingiva. Non-fluoride organic toothpaste should be used, and the stability of mercury amalgams assessed by a dentist with a view to replacement with composite fillings. Lead or heavy metal exposure is another possible cause.

Diet

The adequacy of the diet must be assessed to supply the body with tissue and bone-building nutrients, as well as support for the immune system. A deficiency of vitamin C or A will affect tissue integrity. Sugary snacks and soft drinks are to be avoided, reduce red meat consumption and increase oily fish. Drink adequate water to hydrate the body and saliva. Adequate fruit and vegetables as well as regular vegetable juices provide bone-building minerals and nutrients and alkalise the body. Consume kefir and natural yoghurt. Vitamin D enhances mineral absorption and regulates immunity.

Herbs

The gums can be treated with topical marigold tincture, myrrh, plantain, gotu kola or golden seal diluted as necessary to make a mouthwash to use following brushing. The gums can also be rubbed with aloe vera. Garlic, echinacea, zinc and vitamin C should be taken regularly to support immunity. Antiseptic and anti-inflammatory teas include sage, green tea, chamomile and thyme. Receding gums can be supported with horsetail, gotu cola and plantain to support connective tissue. Curcumin, pomegranate, Aloe, green tea, and grape seed extract are supported by a large evidence base. Green tea is as effective as chlorhexidine. Oates, liquorice, withania and Siberian ginseng will assist with stress.

Cell Salts

Silica 6x will support gum tissue, treat boils and infection (pyorrhoea). Calc-phos is used for weak teeth in children and Calc-fluor is for connective tissue integrity. Ferrum phos 6x will treat inflammation and bleeding. Kali-phos and Mag-phos are for stress which adversely affects the immune system.

Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.