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The presence of bleeding gums usually when brushing or flossing is usually a sign that you have some form of periodontal disease but it can also mean a greater risk is present. Persistent gingival bleeding can be due to something far more serious. This type of bleeding has been linked to diseases such as leukemia, blood platelet disorders, and even scurvy.

Many people sometimes mistakenly believe that bleeding upon brushing or flossing is normal. They might say that their gums always bleed when brushing and so do some of their other family member’s.

Are bleeding gums normal?……NO! Healthy gums do not bleed from normal brushing and flossing.

Bleeding gums in their earliest form is a sign of ginigivits. Gingivitis is simply inflammation of the gum tissues. It is the earliest stage of periodontal disease and is reversible if treated before it progresses. Periodontal disease is a progressive disease that will advance without proper treatment. Periodontal disease is inflammation and infection that breaks down and destroys the tissues that support the teeth. This  includes the gum tissues, the periodontal ligaments (PDL), and the bone supporting the teeth.

Gingivitis comes from the long term effects of deposits of plaque on your teeth. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed protein layer,( the pellicle) on the teeth. The pellicle is like a microscopic cuticle which grows out from under the gum tissue and allows bacteria to use it as a scaffold to build upon. This pellicle layer is removed during a professional cleaning, it does not come off with a toothbrush.

Periodontal Disease - Gingivitis

Periodontal Disease – Gingivtis

The accumulated plaque bacteria and the toxins produced cause the gums to become infected, swollen, and tender. The body responds by sending blood cells ( inflammatory cells) to attack the bacteria, and the bleeding begins.

If you watch television at all, you have probably heard of gingivitis. A very big industry has been built with various types of products that are supposed to eliminate gingivitis. The problem is that most of these products do not work on their own to eliminate ginigivitis or advanced periodontal disease. They work to make your teeth “feel” clean and as a helpful aid in between visits to maintain oral hygiene. Nothing replaces visits to the dentist and hygienist for a proper examination and thorough cleaning to remove the pellicle and bacteria film.

If the plaque is not removed, eventually it will stick to a harder substance known as tartar. While the tartar is not formed directly from the plaque it is able to stick more readily to teeth because of the presence of the plaque. The tartar will be hard and will trap food particles, plaque and bacteria below the gum line.

Researchers have long recognized that there are at least 11 different strains of bacteria that can cause periodontal disease. These bacteria thrive in dark, moist areas. This includes the gingival tissues around the teeth. Our immune systems react to the problem by sending out cells to remove the bacteria. Blood to the infected area is also increased to help flush away the invading bacteria. However, if the invading bacteria do not leave, our gingival tissues become filled with blood and our gums can bleed when we brush. This makes it very difficult to maintain oral hygiene for the patient.  This will ultimately advance to more progressive forms of periodontal disease called periodontitis. Periodontal disease at this stage unfortunately is not truly reversible. Modern dentistry has newer techniques to deal with periodontal disease. These include emdogain, a gum and bone growth factor,  and arestin, a tetracyline type antibiotic.


Periodontal Disease – Periogen

There is a new product on the market called Periogen. This product is used as an adjunct to professional cleanings to help dissolve some of the tartar, plaque and stains that builds up in the mouth. This product has shown the ability to dissolve subgingival (below the gum line) calculus through an in-home, daily irrigation regimen.  It is recommended to use this product with a waterpik ultra to allow penetration of the product below the gum line. The results of this innovative treatment include a reduction to many gum infections and the reduction of many periodontal  pockets. This product has been shown to be very helpful in the reduction of periodontal disease.

What Raises your Risk for Ginigivitis and Periodontal Disease?

Certain infections and systemic diseases. There are some very serious reasons for gums that bleed. These can include blood disorders, clotting disorders, liver problems, kidney disorders, artery or capillary diseases, and diabetes and heart problems. Vitamin C and K deficiencies can also result in bleeding gums. Fungal infections are also linked with bleeding tissues, as well as certain medications such as aspirin, high blood pressure medications, (calcium channel blockers) and blood thinners.

Maintaining poor oral hygiene. If you do not keep your teeth clean with a diligient at home oral hygiene program coupled with regular visits to the dentist you will eventually develop some form of gingivitis as well as increased posssibility of more advanced periodontal disease.

Pregnancy. Hormonal changes at this time will cause changes to your oral cavity. These changes can increase your chances of developing cavities, gingivitis, and advancement of periodontal disease.

Studies have shown that women with periodontal disease are 7X more likely to have preterm births and low birth weight babies. Preventive dental cleanings and regular dental exams during pregnancy are not only completely safe, but are highly recommended by both dentists and physicians alike.

Uncontrolled diabetes. Diabetes impairs white blood cells, which are the body’s main defense against bacterial infections.  These bacterial infections can affect everything in the mouth as well as the rest of the body. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.

Misaligned, crooked teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (braces, dentures, bridges, and crowns). Crowded teeth are much more difficult to maintain and keep clean. This will pose a greater challenge for those patients and mean they need to work a little harder to avoid the pitfalls of periodontal disease.

Many people have some amount of gingivitis. It usually develops during puberty or early adulthood due to hormonal changes. It may persist or recur frequently, depending on the health of your teeth and gums.

Dental and Periodontal Examinations

The dentist will examine your mouth and teeth and make notations if soft, swollen, reddish-purple gums are present. This gum tissue is usually painless or slightly tender at this point. Plaque and tartar will more than likely be present to some degree. A periodontal probe will be used to measure around the teeth to see if your periodontal disease has progressed past just gingivitis. Remember, once bone loss has occurred you now have a more advanced form of periodontal disease.

Following examination, your dentist will recommend a course of treatment for your periodontal disease. This will include a professional cleaning along with extra home care instructions. The goal in treatment is to reduce the inflammation and not allow the periodontal disease to progress. An antibacterial rinse may also be recommended for at home use. A good example of this is Listerine. Your dentist may also recommend repair of misaligned or crooked teeth to aid you in your home care efforts. Also, most people do fine on a 6 month schedule but, everyone accumulates pellicle and plaque at different rates, your dentist may recommend a more frequent schedule for you.

Periodontal Examination

Periodontal Disease Examination

Once the plaque and tartar are removed, bleeding and tenderness of the gums should lessen within 1-2 weeks after professional cleaning and careful oral hygiene. Warm salt water or antibacterial rinses can reduce gum inflammation. Taking an over the counter anti inflammatory medication can also aid in pain and inflammation reduction.

Healthy gums should look pink and firm with no bleeding upon brushing or flossing. Strict oral hygiene must be maintained for your whole life, or periodontal disease will come back and possibly advance past the gingivitis form into advanced periodontal disease (also called periodontitis).

Home Care to prevent periodontal disease should include:

-Regular dental visits. Usually recommended every 3- 6 months for examination and professional cleaning.

Brushing after every meal and flossing at least once a day.

-Rinsing with antiseptic rinse as recommended by dentist.

Consult your physician if the bleeding is severe or chronic, gums continue to bleed even after dental treatment, or you have other unexplained symptoms along with the bleeding from your gums. These could all be the sign of a more serious condition than periodontal disease and should be checked out as soon as possible.

Periodontal disease in its earliest stages is very treatable and should be stopped in its tracks. Everybody has it in their power to keep periodontal disease from progressing to more advanced stages.

Periodontal Disease and Bleeding Gums…Linked?
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dental care multiple sclerosis

How Multiple Sclerosis Works

Multiple Sclerosis (also just simply referred to as MS)  is an autoimmune disease in which the body attacks the nerve fibers of the  brain and spinal cord. Multiple Sclerosis is a progressive disease. This later results in demyelination of the nerve fibers and  paralysis. Demyelination is the general term for diseases of the nervous system.  Demyelination occurs when the myelin sheath (covering of nerve fibers) gets damaged. This in turn results in disorders or impairments in muscle functions, cognition and sensation. For reasons unknown, it mostly affects adults living in the northern hemisphere. Canada has one of the highest rates of Multiple sclerosis in the world.

Multiple sclerosis is just one form of demyelination and also the most common  type. Other diseases include Acute Disseminated Encephalomyelitis and Transverse Myelitis. The disorder was first described by Jean-Martin Charcot in 1868.

Specific symptoms of multiple sclerosis can include:

-Muscle spasms

-Trouble maintaining a good balancing

-Easily fatigued

-Difficulty walking

-Difficulty moving the arms or legs and tremors in the arms or legs.

Additional symptoms include constipation, the need for frequent urination, loss of bladder control, double vision, vision loss, facial pain, depression and hearing loss. These symptoms can occur intermittently and can intensify during times of stress, sun exposure, fever or when taking a hot bath.

Multiple Sclerosis Risk factors

These factors can increase your chances of developing multiple sclerosis:

-Age. multiple sclerosis can develop at any age, but generally affects people between the ages 16-55.

-Sex. Women are more than 2-3X as likely as men are to have multiple sclerosis.

-Familial history. If a parent or sibling has had multiple sclerosis, you are at an increased risk of developing the disease.

-Infections. A variety of viruses have been linked to multiple sclerosis, including Epstein-Barr (infectious mononucleosis).

-Ethnicity. White people, particularly those of Northern European descent, are at highest risk of developing multiple sclerosis. People with ethnic backgrounds of Asian, African or Native American descent have the lowest risk.

-Climate Factors. Multiple sclerosis is much more prevalent in locations with temperate climates. This includes Canada, the northern United States, New Zealand, southeastern Australia and Europe.

Vitamin D. Having low levels of vitamin D and low exposure to sunlight is associated with a greater risk of multiple sclerosis.

-Autoimmune Disease Link. A slightly higher risk of developing multiple sclerosis is possible if you have thyroid disease, type 1 diabetes or inflammatory bowel disease.

-Smoking. Smokers who experience an initial event of symptoms that may signal multiple sclerosis are more likely than nonsmokers to develop a second event that confirms multiple sclerosis.

Treatment for multiple sclerosis includes taking medications to slow the progression of the disease. These include interferon, natazalizumab, methotrexate, azathioprine, cyclophosphamide or steroids. Amantadine may be taken for fatigue, antidepressants may be taken to control mood and behavior, and cholinergic medications can soothe urinary problems. Physical therapy, relaxation and exercise may also be used to manage multiple sclerosis.

One of the parallel connections between multiple sclerosis and the patient’s oral health is loss of muscle control. A patient with MS experiences a harder time brushing their teeth depending on the muscles involved in the patients MS. Due to poor muscle control sometimes MS patients can only achieve what is considered poor brushing. Those suffering from severe multiple sclerosis symptoms will need help from family and loved ones to simply clean their teeth.

dental care in multiple sclerosisMultiple sclerosis patients may also have a difficult time simply relaxing in the dentist’s chair. This makes it very difficult for the dentist to do a thorough dental examination as well as to conduct any needed dental procedures. For this reason, it is imperative to keep Multiple Sclerosis patients in the chair for as little time as possible. Appointments should be as short as possible. Multiple breaks of 5-10 minutes per half hour of treatment should be given. It is also recommended to schedule early morning appointments as this is usually the least stressful part of the day. This is all to lessen the discomfort on the patient. Stress, fatigue, and muscle spasms may also play an important factor in chair time.

Patients suffering from multiple sclerosis are not advised to wear dentures. Muscle spasticity makes it difficult to wear dentures comfortably. The reason is due to the patients uncontrollable muscle spasms. Experiencing uncontrollable spasms could potentially result in dislodgement of the dentures or even swallowing of the denture.

Multiple sclerosis patients need regular dental care not only for reasons mentioned above but there are other factors. Tooth decay, halitosis, or periodontal disease can also occur at higher rates in these patients. All of these can easily be avoided with proper hygiene.

Multiple sclerosis may also cause pain in a specific tooth. This causes the patient to seek care on what is essentially a healthy tooth. This is caused by Trigeminal Neuralgia and is probably the most intensely painful multiple sclerosis related symptom. This can occur in the lower part of the face and is usually an intense, sharp pain. Luckily, this is rare with only about 4% of Multiple Sclerosis patients experiencing this type of pain.

There is no cure for Multiple Sclerosis. Dentists have a few set rules for management of patients with MS:

1. Maintain oral function. Allow patient to be as self sufficient as they can for as long as possible.

2. Keep patient healthy so they do not develop other disorders or diseases that could complicate their MS.

3. Maintain a person’s cosmetic appearance so they do not develop self esteem issues which will further accelerate their decline via depression.

If you have noticed, one of the primary concerns of dentists is for the patient to be able to maintain their own oral hygiene. This is achievable especially with patients whose condition has not yet reached its worst. In cases where this is not possible, family members or care givers are trained to assist the patient.

Lastly, maintaining positive attitude towards life is very important. There are a lot of people suffering from diseases and ailments worse than multiple sclerosis. If the dentist, patient, and family work together a Multiple Sclerosis patient can live free of dental worries their entire lives.