Gingivitis is a common gum disease that causes inflammation of the gums. It is usually caused by poor oral hygiene that allows plaque – a sticky film of bacteria – to build up on the teeth. In severe cases, gingivitis can progress to periodontitis and eventually lead to tooth loss if left untreated. So how do dentists go about treating severe gingivitis?
What is Severe Gingivitis?
Gingivitis is classified as mild, moderate or severe based on various factors. In mild gingivitis, there may be slight redness and swelling of the gums with minimal bleeding when brushing or flossing. Moderate gingivitis exhibits more pronounced symptoms with red, swollen, and tender gums that bleed easily when disturbed. Severe gingivitis is characterized by significant inflammation, bleeding, discomfort, and halitosis (bad breath). There may be ulcers or abscesses on the gums. The gums may begin to recede in severe gingivitis, exposing the tooth roots. Severe gingivitis often quickly advances to mild periodontitis as the inflammation spreads deeper below the gum line.
Initial Examination
When a patient comes in with suspected severe gingivitis, the dentist will first perform a thorough examination of the teeth and gums. They will check for plaque buildup, tartar, gum recession, periodontal pockets, bleeding, swelling, and ulcers. The dentist will measure periodontal pocket depths around each tooth using a periodontal probe. Pockets deeper than 3-4 mm indicate progression from gingivitis to periodontitis. Radiographs may be taken to check for bone loss characteristic of periodontitis. The dentist will also review the patient’s symptoms, medical history, and oral hygiene routine.
Professional Dental Cleaning
After the initial exam, the first step in treating severe gingivitis is a professional deep cleaning of the teeth. This is done to remove the plaque and tartar that is irritating the gums and driving the inflammation. The dentist or hygienist will numb the gums and then thoroughly scale and root plane all surfaces of the teeth. Scalers and ultrasonic devices are used to meticulously clean above and below the gum line. Difficult buildup may be removed with hand tools or lasers. This professional cleaning reduces the bacterial load and irritants that cause gingivitis.
Oral Hygiene Instructions
The dentist will emphasize the importance of excellent daily oral hygiene to control plaque buildup. Thorough twice daily brushing with a soft-bristled brush is recommended. The dentist may suggest special toothpaste or mouthwash. Flossing once daily is extremely important as well. The patient is instructed to gently brush the gums and to take extra care cleaning in between the teeth. Use of interdental cleaners like floss picks may be beneficial. Stopping smoking and limiting sugary foods will also help reduce gingivitis risk.
Medications and Mouth Rinses
The dentist may prescribe medicated mouth rinses like chlorhexidine to use in conjunction with daily brushing and flossing. These antiseptic rinses kill bacteria and help control plaque between teeth. Antibiotics or antimicrobials may be prescribed to bring severe gingivitis and early periodontitis under control. Anti-inflammatory pain medication like ibuprofen may be recommended to relieve discomfort from the inflamed gums.
Further Deep Cleanings
Additional professional dental cleanings may be scheduled to reinforce oral hygiene and prevent a relapse of severe gingivitis. The dentist will monitor and measure gum pocket depths and bleeding to assess if further deep cleanings are indicated. For patients with recurring moderate to severe gingivitis, professional cleanings every 3 months may be recommended. The dentist may also suggest adjunctive therapies like antimicrobial photodynamic therapy to kill stubborn bacteria in periodontal pockets.
Gum Surgery
If significant gum recession is present or severe gingivitis has progressed to moderate or advanced periodontitis, gum surgery may be warranted. There are several different periodontal surgical procedures that can treat gum disease and regrow lost gum tissues. Common surgeries include flap surgery, bone and tissue grafts, guided tissue regeneration with membrane barriers, and laser therapy to remove diseased gum tissues. These procedures are typically performed by a specialist called a periodontist.
Ongoing Monitoring
Following active treatment of severe gingivitis, the dentist will want to see the patient periodically for reevaluation and professional cleanings. Typically, follow-up visits are scheduled starting at 3 months after treatment is completed, then once every 6 months. It is imperative for the patient to maintain excellent oral hygiene and follow any other recommendations to prevent recurrence of severe gum inflammation, bleeding, and discomfort.
Home Remedies
In addition to professional dental treatment, there are some natural remedies that can provide relief for inflamed gums at home. Here are some options:
- Salt water rinse – Mix 1 tsp salt in 1 cup warm water and rinse for 30 seconds 2-3 times a day.
- Aloe vera gel – Soothes inflamed gums.
- Green tea bags – Contains antioxidants to reduce inflammation. Apply cooled tea bag to gums.
- Coconut oil – Has antibacterial and anti-inflammatory properties. Rub a little on gums.
- Cloves – Contain eugenol to numb gums. Make a paste with ground cloves.
While home remedies can temporarily relieve discomfort, professional dental treatment is still required to truly resolve severe gingivitis.
When to See a Dentist
You should make an appointment with your dentist if you notice any of the following symptoms:
- Gums that are very red, swollen or painful
- Bleeding when you brush or floss
- Gums that have pulled away from your teeth
- Pus coming from between your teeth and gums
- Bad breath or foul taste that won’t go away
- Permanent teeth feeling loose or separating
Prompt dental treatment is necessary at the first signs of severe gingivitis to prevent permanent damage to the gums and bone that support the teeth. Left untreated, severe gum inflammation can quickly progress to advanced periodontitis and eventual tooth loss.
Preventing Gingivitis
Practicing good oral hygiene and having regular professional cleanings are key to preventing gingivitis. Here are some tips:
- Brush teeth thoroughly twice a day
- Floss between all teeth daily
- Use antiseptic mouthwash
- Clean between teeth with interdental brushes
- Eat a balanced diet low in sugar
- Drink plenty of water
- Don’t smoke or use chewing tobacco
- Get dental cleanings every 6 months
Catching gingivitis early and keeping up with daily oral hygiene practices can stop mild cases from progressing to severe stages requiring more complex dental treatment.
Conclusion
Severe gingivitis must be treated promptly and thoroughly to halt tissue damage and bone loss around teeth. The standard treatment plan includes:
- Complete dental exam and measurement of gum pockets
- Professional deep cleaning above and below the gumline
- Oral hygiene instructions for brushing and flossing
- Prescription antimicrobial mouth rinse
- Follow up visits and cleanings every 3-6 months
- Periodontal surgery if gum recession and bone loss is significant
Careful daily brushing and flossing along with regular professional cleanings and checkups are imperative to manage severe gingivitis and prevent the progression of gum disease. Avoiding tobacco and limiting sugar intake can also help control gingivitis. With proper treatment and excellent oral care, the symptoms of severe gingivitis can be reversed and more serious complications avoided.