GINGIVITIS

Gingivitis inflammation of the gum tissue

Non-destructive periodontal disease. [1]

Most common form of gingivitis is in response to bacterial biofilms (also called plaque)

In the absence of treatment, gingivitis may progress to periodontitis , which is a destructive form of periodontal disease. [2] dontitis, [3] data indicates that periodontitis is always preceded by gingivitis. [4]

The symptoms of gingivitis are:

• Swollen gums
• Bright red or purple gums
• Gums that are tender or painful to the touch
• Additionally, the stippling that normally exists on the gum tissue of some individuals will often disappear and the gums may appear shiny when the gum tissue becomes swollen
• The accumulation may also emit an unpleasant odor.
• When the gingiva are swollen, the epithelial lining of the gingival crevice becomes ulcerated and the gums will bleed more easily with even gentle brushing, and especially when flossing.

Etiology, or cause is bacterial plaque, which acts to initiate the body's host response plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that serve to accumulate and maintain plaque. Examples of plaque traps include bulky and overhanging restorative margins, claps of removable partial dentures and calculus (tartar) that forms on teeth. Although these accumulations may be tiny, the bacteria in them produce chemicals, such as degradative enzymes, and toxins, such as lipopolysaccharide (LPS, otherwise known as endotoxin ) or lipoteichoic acid (LTA), that promote an inflammatory response in the gum tissue

Diagnosis

Look for signs of periodontitis using X-rays or periodontal probing as well as other methods.

Prevented through regular oral hygiene that includes daily brushing and flossing Interdental brushes

Hydrogen peroxide, saline, essential oils, alcohol or chlorhexidine mouth washes may also be employed toothpaste containing triclosan effective [8] In many countries, such as the U S, mouthwashes containing chlorhexidine are available only by prescription. But you can easily purchase guns

the reduction of oral bacteria regular periodic visits to a dent together with adequate oral hygiene home care

• The American Academy of Periodontology. Proceedings of the World Workshop in Clinical Periodontics. Chicago: The American Academy of Periodontology; 1989:I/23-I/24.
• AAP Parameters of Care: Plaque-Induced Gingivitis J Perio 2000;71:851-852
• Ammons, WF; Schectman, LR; Page, RC. Host tissue response in chronic periodontal disease I: The normal periodontium and clinical and anatomic manifestations of periodontal disease in the marmoset. J Perio Res1972;7:131
• Page, RC; Schroeder, HE. Pathogenesis of Inflammatory Periodontal Disease: A Summary of Current Work. Lab Invest 1976;34(3):235-249
• Armitage, GC. Development of a Classification System for Periodontal Diseases and Conditions Ann Periodontol1999;4:1-6
• Academy Report: Treatment of Plaque-Induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions J Perio 2001;72:1790-1800.
• American Dental Hygienists’ Association Position Paper on the Oral Prophylaxis.
• FDA Triclosan: What Consumers Should Know Accessed 2010-08-12
• http://www.perio.org/consumer/calcium.htm
• Institute for Good Medicine at the Pennsylvania Medical Society, http://www.myfamilywellness

Gold

Gold, the most noble of metals, seldom tarnishes or corrodes in the oral cavity

Gold is frequently used in combination with other metals silver, copper, platinum, palladium, and zinc to produce alloys that can be used to fabricate various types of dental restorations

Of all Crowns full gold crowns last the longest, as they are fabricated as a single piece of gold. Porcelain-fused-to-metal crowns(PFM) are prone to failure, as they incorporate brittle porcelain into their structure. Although incredibly strong in compression, porcelain is terribly fragile in tension. A traditional PFM with occlusal porcelain (i.e. porcelain applied to the biting surface of a posterior tooth) has a 7% higher chance of failure per year than a corresponding full gold crown see Porcelain Fracture

Golden Rule

• This “secret precious jewel of nature and beauty” Kepler 1600AD, is also known as:
  • Fibonacci Ratio or Progression or Series
  • Sacred Geometry
  • Sacred or Divine Cut
  • Divine Proportion
  • Divine Section
  • Golden Section
  • Golden Sector
  • Golden Proportion
  • Golden Number
  • Golden Cut
  • Golden Mean
  • Extreme and Mean Ratio
  • Medial Section
  • Phi and
  • Mean of Phidias

  All of these names describe the very same thing with a precise value. It may be expressed as an equation or algorithm, as a percentage, a ratio, a proportion or a numerical progression

• The Golden Rule allows us to connect nature and science. It captures the essence of nature in a very simple equation. The ratio is seen universally in “Mother Nature” from the microscopic to the swirls of the galaxies. It is seen in linear proportions such as facial and body proportions, classical and modern architecture as well as in various curves and spirals.
• The Golden Rule is represented by the Greek letters Φ or φ (phi, after the sculptor Phidias)or less commonly by τ(tau, Greek for “to cut”)
• The Divine Cut describes a ratio or percentage that is meant to have perfect proportions. Take a length of ropeC: Divide C into two by one cut that results in A and B, Where the ratio of AtoB is exactly the same as BtoC There is only one place to cut, called the Golden, Sacred or Divine Cut and happens to equal 61.8%.
  The two lines are said to be in Golden Ratio since the proportion of the smaller to the greater is the same as the greater to the whole. The cut in the line represents a point of equilibrium where quantities. Volumes and areas are sensed to be in aesthetic balance.
• The Fibonacci Progression: 1 3 5 8 13 21 34 45 …..etc is derived by adding the previous number to the current number to get the next number e.g. 5 + 8 = 13, 8 + 13 = 21 and so on. Again here, if one divides any number in this progression by the next number the result is the Golden Ratio or percentage .618 The Fibonacci progression may be looked at philosophically in that it could reflect the natural and logical progression through life, as one naturally proceeds to a magical summation of the present plus the past. That is, ones future is determined by the past plus the current position.
• “It is probably fair to say that the Golden Ratio has inspired thinkers of all discipline like no other number in the history of mathemematics” Mario Livio, The Golden ratio: The Story of Phi, The World’s Most Astonishing Number, p6 It has fascinated Western intellectuals of diverse interests for at least 2,500 years.

Phidias (450 BCE), Da Vinci (1450 AD),Dürer(1528 AD), Dali (20th century), Mondrian (20th century) Leonardo da Vinci's famous study Vitruvian Man (1487) of the square and the circle shows the figure of a man contained within a square as well as within a circle. The centre of the circle, the umbilical navel, divides the body into a larger part and a smaller upper part conforming to the Golden Proportion


Architecture–Vitruvius (50 BCE)

Pyramids

The Great Pyramid of Giza’s slope of 51° 52' is extremely close to the "golden" pyramid inclination of 51° 50' other pyramids at Giza (Chephren, 52° 20', and Mycerinus, 50° 47')[70] are also quite close. Eli Maor, Trigonometric Delights, Princeton Univ. Press, 2000

Vyse reported the great pyramid height 148.2 m, and half-base 116.4 m, yielding 1.6189 for the ratio of slant height to half-base. Eric Temple Bell, The Development of Mathematics, New York: Dover, 1940, p.40

The Parthenon facade is a Golden Rectangle
The Swiss architect Le Corbusier described the golden ratio and the Fibonacci series as "rhythms” that “are at the very root of human activities. They resound in man by an organic inevitability, the same fine inevitability which causes the tracing out of the Golden Section by children, old men, savages and the learned."[25]

• Arithmetics Pythagorus (550BCE),Euclid (300BCE), Fibonacci (1200AD), Pacioli (1500AD), Gardner (1966), Huntley (1970)
• The Golden Rectangle
  
  • Draw a square (red).
  • Draw a line from the midpoint of one side to an opposite corner.
  • Use that line as the radius to draw an arc that defines the long dimension of the rectangle.
    

    

    

    

    When squares based on the Fibonacci Series are contiguously attached and a curved line is drawn based on these squares an asethetically pleasing equiangular spiral is produced. This spiral is seen ubiquitous in nature.

    

    

    

    

    

    Euclid's treatise of thirteen books on Geometry which he called "The Elements". Completed in Alexandria in 300 BCE, it is still considered to be the best book ever written on elementary mathematics or ever likely to be written (Coxeter 1980)

    Leonardo Fibonacci’s“ The Liber Abaci” (1202) is still considered one of the best books written on arithmetics. It was the principal means of demonstrating the enormous advantages of the Hindu Arabic number System over the Roman System. His reputation amongst scholars was so great that King Frederick II, visiting Pisa in 1225, held a public competition in mathematics to test Leonardo's skill and he was the only one able to answer the questions (Huntley 158)

    
  • The pentagon is a 5 sided figure one of the Platonic solids exhibits Golden proportions in its linear dimensions
  • Designers in the shapes of postcards, playing cards, posters, wide-screen televisions, photographs, canvases and light switch plates
  • Music Chopin, Debussy, Satie, Bartok (1900),Lendvai (1971) Roy Howat (1983). Debussy in Proportion: A Musical Analysis. Cambridge University Press Pearl Drums positions the air vents on its Masters Premium models based on the golden ratio. The company claims that this arrangement improves bass response and has applied for a patent on this innovation Pearl Masters Premium Pearl Corporation www.pearldrum.com/premium-birch.asp.

  • Science and Biology– Hambridge 1921, Thompson 1952, Coxeter 1961, Doczi 1980
    

    

    Metacarpal bones conforming to Golden Ratios

    

    The New Scientist Dec.1981 featured on its cover a daisy head showing the double spiral. The article then went on to discuss the Fibonacci series, showing other examples of the double spirals in nature and comparing them to computer generated double spirals. The writers also postulated an explanation for the way plants' growth illustrates the Fibonacci series in the position and spacing of the leaves

    (Phylotaxis.)http://books.google.com.au/books?id=ccJ27ly1_-MC&pg=PA792&dq=Fibonacci&hl=en&ei=-CUxTdCWBIeyceWZ4Rg&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC8Q6AEwAA#v=onepage&q=Fibonacci&f=false

    In 2003, Volkmar Weiss and Harald Weiss analysed psychometric data and theoretical considerations and concluded that the golden ratio underlies the clock cycle of brain waves. In 2008 this was empirically confirmed by a group of neurobiologists Weiss, Volkmar; Weiss, Harald (2003).The golden mean as clock cycle of brain waves. Chaos, Solitons and Fractals 18: 643–652.

    In 2010, the journal Science reported that the golden ratio is present at the atomic scale in the magnetic resonance of spins in cobalt niobate crystals Roopun, Anita K.; et al.; Carracedo, LM; Kaiser, M; Davies, CH; Traub, RD; Kopell, NJ; Whittington, MA (2008). Temporal interactions between cortical rhythms. Frontiers in Neuroscience 2 (2): 145–154

    Several researchers have proposed connections between the golden ratio and human genomeDNAYamagishi, Michel E.B., and Shimabukuro, Alex I. (2007), "Nucleotide Frequencies in Human Genome and Fibonacci Numbers", in Bulletin of Mathematical Biology Perez, J.-C. (September 2010). "Codon populations in single-stranded whole human genome DNA are fractal and fine-tuned by the Golden Ratio 1.618". Interdisciplinary Sciences: Computational Life Science 2 (3): 228-240. doi:10.1007/s12539-010-0022-0

  • Modern stock traders Technical Analysis used by individuals and multinationals use Fibonacci Ratios for support and resistance levels. These levels exist de facto ie whether by nature or by mass psychology people expect them and the stock prices respond accordingly.
  
  
  
  
  • Philosophers – Plato (400 BCE), Agrippa (1500AD), Koestler (1962)
  • Leon Battista Alberti (1404 – 1472) was an Italian author, artist, architect, poet, priest, linguist, philosopher and cryptographer, and general Renaissance humanist often seen as a model of the Renaissance "universal man".
  • Adolf Zeising, whose main interests were mathematics and philosophy, wrote in 1854 a universal law "in which is contained the ground-principle of all formative striving for beauty and completeness in the realms of both nature and art, and which permeates, as a paramount spiritual ideal, all structures, forms and proportions, whether cosmic or individual, organic or inorganic, acoustic or optical; which finds its fullest realization, however, in the human form."

  The Golden Rule is well embedded in the human psyche

  Guarantees

  Do dentists provide guarantees for workmanship?

  No treatment can be "guaranteed", either in terms of its 'cure' or by a length of time

  Dentists are skilled professionals who practice with utmost care and responsibility. We cannot always foresee what may or may not happen due to natural causes or unpredictable complications

  We at SAS dental discuss with you the prognosis, or likely outcomes of various treatment options, on which to base a final decision

  Gum Disease Periodontitis/Periodontal Disease/Jaw Bone Disease

  Previously known as Pyorrhoea

  Teeth are meant to last a lifetime.

  If teeth don’t last it is usually the result of gum disease because here the support for teeth - bone - is lost or “dissolved”.

  Of the three most common oral pathologies (excessive grinding, decay and gum disease) gum disease or periodontitis has the potential to be the most dangerous and damaging.
  This is because:

  • Its insidious nature as in the early stages, it has very few symptoms and in many individuals the disease has progressed significantly before they seek treatment.
  • The potential to cause acute pain a swelling
  • The loss of function with loss of teeth
  • Most importantly its link with serious systemic illnesses

  Many people will have a small amount of periodontitis, which gradually increases with age. However approximately 15% of the population will have a significant degree of periodontitis. Some people ( with a family history )are genetically more likely to develop gum disease but anyone can develop it. The destruction of hard and soft tissue gets worse over time and is often seen more severely in the 45+ age group.

  Teeth are held in bone by what is called the periodontal ligament. This region is a very important site because germs can easily enter the blood stream from here.

  The mouth is the door to the castle called the body.

  If teeth are not cleaned properly and bacteria are allowed to multiply then particularly dangerous and nasty germs called anaerobes start to take over. This is when our immune system starts to hear alarm bells and mounts a defence plan

  PLAN A

  The immune system is responsible for protecting us from foreigners such as microbes and cancers and keeps us alive and living long. If it detects danger it will respond by making more white blood cells and will send them to the danger site to launch a battle. This battle is waged in order to prevent these dangerous bacteria from entering our precious body and causing trouble elsewhere such as the heart and brain. But the battle can be frustrating and very costly akin to two countries fighting a long and very expensive drawn out “chronic” war with much death and destruction. If we ignore the early signs and continue to not clean our teeth properly then the immune system puts into action

  PLAN B

  This is where bone starts to shrink away from the teeth and the teeth eventually become loose and fall out. This is akin to a country using an atomic bomb to blast another country off the map. The Plan B mission is to remove all our teeth so the gums can heal over and finally provide a more protective barrier to germs. It means false teeth or implants etc. Gum disease in this sense is very much an autoimmune disease (like type 1 diabetes) where the body (immune system) attacks the supporting bone because that area becomes “infested” with anaerobic germs including fungal species such as Candida and Aspergillus species – the body’s immune system now cannot differentiate between self and a foreign body. So far as the immune system is concerned the constantly plaque covered tooth is a “dirty splinter of wood” and must be removed for the sake of the whole body. The best measure for gum disease is prevention but once established there are steps that can halt and even reverse some damage.

  The effects of early gum disease are largely reversible with appropriate care.

  In the vast majority of cases the progression of gum disease can be arrested with appropriate care.

  Management of gum disease becomes more difficult and less predictable the more advanced the disease. Therefore, the sooner periodontitis is diagnosed and treated the better Regular dental examinations are important to check for the presence of gum disease

  Once this has progressed to periodontitis there is some permanent damage to the ligament and bone that supports and holds the teeth.

  Remember: Gingivitisis totally reversible whereas periodontitis is not

  Progress of disease:

  With ligament and bone loss a space develops between the gum and the tooth called a pocket. The pocket forms a protected environment for more bacteria and the condition progresses. If left untreated periodontitis may cause gum abscesses, facial swelling, tooth loss and worse, initiation or worsening of certain systemic diseases.

  Gingival inflammation and bone destruction are most often largely painless

  Treatment:

  To manage gum disease, the bacteria that caused it must be reduced to a level the body's defense mechanisms can handle. A reduction in plaque not only reduces the bacterial numbers but also the type of bugs in the mouth from the more dangerous anaerobes to friendlier“ mind your own business” aerobes. Thus, as with decay and other diseases what is needed is a change in the environment that caused the problem.
  Fixing holes but continuing a high sugar diet and not brushing properly will result in the same disease. This is why medications are not the solutions to many illnesses but only remedies to symptoms of the disease. If the disease is reversible it will only reverse if the environment, in the case of decay – ACID – is reversed.
  At SAS Dental treatment is centred around 5 steps:

  • Education on the condition, cause and solution
  • Achieving the best possible home care see oral hygiene
  • Professional cleaning of the teeth above and below the gum line (subgingival - into the pockets) to remove the plaque and hard deposits (calculus / tartar)
  • Regular reviews and feedback
  • Removal or reduction of risk factors such as:

  Smoking dry mouth nutritional deficiencies “selenium has the strongest association with gum disease, with low levels increasing the risk by 13 fold." and "Clearly, low levels of most antioxidants are a risk factor for periodontal disease and infection," First Evidence Found Of Link Between Gum Disease And High Alcohol Consumption, Low Dietary Antioxidants 1999. University of Buffalo.

  diabetes note importance of finger prick screening medical conditions particularly involving the immune system stress (an interesting correlation found by some researchers) Peruzzo et al "A Systematic Review of Stress and Psychological Factors as Possible Risk Factors for Periodontal Disease". Journal of Periodontology 78 (8): 1491–1504.

  We may also recommend you visit a Periodontist if your condition needs specialist attention. Summarizing, Periodontitis is caused by microorganisms that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these microorganisms. A definitive diagnosis is established by first collecting data on:

• Typical warning signs and symptoms such as:
  • Redness or bleeding of gums while brushing, flossing or biting into hard food (e.g. apples)
  • Bad breath or taste in your mouth (may be metallic)
  • Gum recession
  • Tender teeth
  • Reoccurence of painful, swollen and tender gums
  • Loose teeth or teeth that have moved(this usually occurs in the later stages but may also be due to other reasons such as bruxism)
• Soft tissues around the tooth by inspection/examination with a probe


Radiographic examination (x rays) to determine the amount of bone loss around the teeth

Gum Surgery
See also Laser Gum Surgery

Gum Surgery

See also Laser Gum Surgery

Gum Gingiva



Mucosa

Gingiva

From Wikipedia, the free encyclopedia

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"Gums" redirects here. For other uses, see Gum (disambiguation).

Cross-section of a tooth with visible gums, or gingiva

Gray's	subject #242 1112
MeSH	Gingiva

The gingiva (sing. and plur.:gingiva), or gums, consists of the mucosal issue that lies over the alveolar bone.

General Description

Gingiva are part of the soft tissue lining of the mouth. They surround the teeth and provide a seal around them. Compared with the soft tissue linings of the lips and cheeks, most of the gingiva are tightly bound to the underlying bone which helps resist the friction of food passing over them. Healthy gingiva is usually coral pink, but may contain physiologic pigmentation. Changes in colour, particularly increased redness, together with edema and an increased tendency to bleed, suggest an inflammation that is possibly due to the accumulation of bacterial plaque.

A diagram of the periodontium. A, crown of the tooth, covered by enamel.B,root of the tooth,covered by cementum.C, alveolar bone.D, subepithelial connective tissue.E, oral epithelium.F, free gingival margin.G, gingival sulcus.H, principle gingival fibers. I, alveolar crest fibers of the PDL. J, horizontal fibers of the PDL.K, oblique fibers of the PDL.

Macroscopic Features of Gingiva

The gingiva is divided anatomically into marginal, attached and interdental areas.

Marginal gingiva

The marginal gingiva is the terminal edge of gingiva surrounding the teeth in collar like fashion. In about half of individuals, it is demarcated from the adjacent, attached gingiva by a shallow linear depression, the free gingival groove. Usually about 1 mm wide, it forms the soft tissue wall of the gingival sulcus . The marginal gingiva is supported and stabilized by the gingival fibers .

Attached gingiva

The attached gingiva is continuous with the marginal gingiva. It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone. The facial aspect of the attached gingiva extends to the relatively loose and movable alveolar mucosa, from which it is demarcated by the mucogingival junction . Attached gingiva may present with surface stippling .

Interdental gingiva

The interdental gingiva occupies the gingival embrasure, which is the interproximal space beneath the area of tooth contact. The interdental gingiva can be pyramidal or have a "col" shape. Attached gingiva is resistant to masticatory forces and always keratinised.

Diseases of the gingiva

The gingival cavity micro ecosystem , fueled by food residues and saliva, can support the growth of many microorganisms, of which some can be injurious to health. Improper or insufficient oral hygiene can thus lead to many gingival and periodontal disorders, including gingivitis or pyorrhoea , which are major causes for tooth failure. Recent studies have also shown that Anabolic Steroids are also closely associated with gingival enlargement requiring a gingivectomy for many cases. Gingival recession is when there is lateral movement of the gingival margin away from the tooth surface. [1] It may indicate an underlying inflammation such as periodontitis [2] or pyorrhoea [2], dry mouth [2] or displacement of the marginal gingivae away from the tooth by mechanical (such as brushing), [2] chemical, or surgical means. [3] Gingival retraction, in turn, may expose the dental neck and leave it vulnerable to the action of external stimuli, and may cause root sensitivity.[2]

Characteristics of healthy gingiva

Colour

Healthy gingiva usually has a colour that has been described as "coral pink." Other colours like red, white, and blue can signify inflammation (gingivitis) or pathology. Although the text book colour of gingiva is "coral pink", normal racial pigmentation makes the gingiva appear darker. Because the colour of gingiva varies due to racial pigmentation, uniformity of colour is more important than the underlying colour itself.

Contour

Healthy gingiva has a smooth or scalloped appearance around each tooth. Healthy gingiva fills and fits each interdental space, unlike the swollen gingiva papilla seen in gingivitis or the empty interdental embrasure seen in periodontal disease. Healthy gums hold tight to each tooth in that the gingival surface narrows to "knife-edge" thin at the free gingival margin . On the other hand, inflamed gums have a "puffy" or "rolled" margin.

Texture

Healthy gingiva has a firm texture that is resistant to movement, and the surface texture often exhibits surface stippling . Unhealthy gingiva, on the other hand, is often swollen and mushy.

Reaction to disturbance

Healthy gums usually have no reaction to normal disturbance such as brushing or periodontal probing. Unhealthy gums on the other hand will show bleeding on probing (BOP) and/or purulent exudate ( pus ).

Additional Images




See also

• Gum graft
• Head and neck anatomy
• Periodontitis

References

• Gingival Recession - Causes and treatment JADA, Vol 138. http://jada.ada.org. Oct 2007. American Dental Association
• abcdemexicodentaldirectory.com > dental sensitivity Retrieved on August 2010
• Mondofacto medical dictionary > gingival retraction 05 Mar 2000