Gingivitis
Gingivitis involves inflammation of the gums surrounding the teeth. Due to this, the gums become soft and swollen and usually red instead of a healthy pink. The inflammation of the gums is a defense mechanism put up by the body's immune system to prevent the growth of bacteria which along with the remnant food particles and plaque form tartar. This cannot be removed by simple brushing or flossing.
What Causes Gingivitis Disease?
The primary cause of gum disease is plaque. However, there are various other reasons why gingivitis disease develops.
- Gums become sensitive when there are hormonal changes in the body, such as during puberty, pregnancy, menopause and menstruation. During pregnancy, hormonal changes and tartar induce excessive growth of gum tissues resulting in the formation of lumps commonly referred to as pregnancy tumors. These tumors prevent bacteria from being removed effectively during brushing, thus resulting in gingivitis disease.
- In post-menopausal women, a painful condition called desquamative gingivitis may develop, for reasons yet unknown. In this condition, the outer layers of the gums come away from the teeth and lose their solidity, resulting in the exposure of nerve-endings which causes acute pain.
- Long-term use of contraceptive pills can also result in gingivitis.
- Diseases that affect the immune system such as HIV or cancer may also affect the gums. Diabetes when uncontrolled, can affect the gums. On the other hand, gingivitis disease may also be a pointer to systemic disorders.
- Some medications can also cause gum disease as they restrict production of saliva which prevent the formation of tartar. Some medications used in the treatment of angina and seizures can cause abnormal growth of the tissues in the gums.
- Habits, such as smoking, do not facilitate the easy self-repair of the gums. A severe form of gingivitis, known as Trench mouth or ANUG (Acute necrotizing ulcerative gingivitis) is mostly found in the case of smokers. ANUG is also reported in the case of incapacitated persons under severe stress. Acute pain, swelling, bleeding and bad breath develop very quickly in this condition and also the gums turn grey.
- If gingivitis runs in the family, then there is a greater chance of a person getting it. Poor oral hygiene is a major contributor to gingivitis.
- Dental appliances not properly fitted or improper alignment of teeth may also cause gingivitis.
- Dietary imbalances, vitamin deficiencies, and drug reactions can also result in gingivitis.
- Gingivitis disease is also often caused by fungal and viral infections.
Symptoms of gingivitis
There is usually no pain associated with mild form of gingivitis. Hence it may go unnoticed. However, there are certain symptoms that warn that treatment for gingivitis is needed:
- When the gums are swollen, soft, or red.
- When gums bleed during, or after brushing.
- When bad breath or bad taste in the mouth persists even after brushing and flossing.
- When the gums recede.
- Deep pockets are formed between teeth and gums.
- Visible deposits of tartar.
If the dentist finds that someone is particularly prone to formation of plaque, he may recommend use of special implements to remove plaque, such as toothpicks, electric toothbrushes etc. This treatment for gingivitis would suffice when the gingivitis disease is in the early stages.
For reducing the pocket depth between teeth and gums, which can also cause gingivitis, dentists undertake root-planing and scaling. In addition dentists may also administer minocycline microspheres. For women who have desquamatic gingivitis, hormone replacement therapy could be beneficial. However, adverse effects of the therapy could prevent their recommendation. Instead, corticosteroid rinses and pastes which can be directly applied on gums may be more commonly recommended.
Pericoronitis is acute, painful inflammation of the gingival tissue over a partly erupted tooth (as in the case of a wisdom tooth). The treatment for this would include removal of the debris beneath the gingival flap and irrigation with saline. This may be followed up with extraction, particularly when there is recurrence of the episode.
Lipoprotein (a) Test
Lipoprotein (a) is synthesized by the liver and is responsible for the initial onset of cardiovascular disease. It is generally found in the inner arterial lining leading to the accumulation of plaque and formation of atherosclerotic particles. This process occurs due to the initiation of foam cell accumulation which gradually leads to the formation of plaque in the coronary arteries. Lipoprotein (a) test is prescribed to analyze the probabilities of premature cardiovascular disease incidence.
Lipid profile under normal or slightly elevated values may have an underlying risk indicating the development of a cardiovascular condition which can be specifically determined by estimating the blood lipoprotein (a) value. The occurrence of lipoprotein (a) levels is a genetic cause which induces the onset of cardiovascular disease. The lifestyle of an individual in relation to cardiovascular disease is not an important factor for the increased lipoprotein (a) values. Lipoprotein (a) has structural similarity with blood clotting factors such as plasminogen which can lead to the formation of blood clots. Increased LDL values may associate with lipoprotein (a) in facilitating cardiovascular disease. The normal value of lipoprotein (a) is 30mg/dl. The test for lipoprotein is usually taken after 12 hours fasting.
Peripheral Vascular Disease
Peripheral Vascular Disease(PVD) or Peripheral artery disease (PAD) is a condition where the arteries supplying blood to the limbs and internal organs get blocked as a consequence of atherosclerosis. Fatty deposits get built up in the arteries and reduce the flow of blood to the organs being supplied by the peripheral arteries. Atherosclerosis is by far the leading cause for Peripheral Vascular Disease. Diabetes is a condition that puts a person at high risk for PVD. Smoking and obesity increases the risk for Peripheral Vascular Disease. Persons who are obese and suffer from hypertension are at higher risk for Peripheral Vascular Disease. A sedentary lifestyle without any exercise should be avoided.
Intermittent claudication is noticed in patients suffering from Peripheral Vascular Disease. Symptoms associated with Peripheral Vascular Disease include numbness or tingling in the limbs, sores that do not heal and pain in the buttocks. A patient suffering from Peripheral Vascular Disease notices changes in skin color and temperature. There may be a dull and cramping pain in the calf, thigh and hip muscles. Ankle Brachial Index (ABI) involves a ratio of the blood pressure in your ankle to the pressure in your arm. Angiogram is a dye test that reveals any possible blockage in the arteries. Ultrasound Doppler Test uses imaging to check for plaque build-up in the arteries. Duplex ultrasound helps in accurate detection of the size of the artery stenosis and the extent of blockage.
Medication is prescribed to eliminate the narrowing of the arteries thereby improving the heart efficiency. Anti-platelet or anti-clotting agents such as cilostazol and pentoxifylline or aspirin and clopidogrel help in improving blood supply to the extremities. Heparin and Warfarin are anticoagulant drugs that can prevent blood clotting. Blood viscocity is controlled to improve blood flow. Drugs to control hypertension and cholesterol may also be prescribed. Bypass surgery allows a new blood route that circumvents the blocked areas of the peripheral arteries. Endarterectomy is a surgical procedure whereby a surgeon cleans out plaque buildup inside the artery of the affected leg or arm. Cryoplasty, a newer form of angioplasty uses liquid nitrous oxide to open a narrowed artery and destroy the plaque within. Regular supervised exercise can reduce symptoms of intermittent claudication.
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