Gum Disease and Bad Breath (Halitosis)

Gum diseases can be categorized into two broad groups, namely gingivitis and periodontitis.

Gingivitis is an inflammation of the gingivae (gums) in all age ranges but manifests more frequently in children and young adults.

Periodontitis is an inflammation with subsequent destruction of the other tooth-supporting structures, namely the alveolar bone, periodontal ligament and cementum and subsequent loss of teeth. This condition mainly manifests in early middle age with severity increasing in the elderly.

Gingivitis can or may progress to periodontitis state in an individual.

Gum diseases have been found to be one of the most widespread chronic diseases the world over with a prevalence of between 90 and 100 per cent in adults over 35 years of age in developing countries. It has also been shown to be the main cause of tooth loss in individuals 40 years and above.

Bad breath is one of the major consequences of gum diseases.

Some of the terms that are greatly associated with bad breath and gum diseases are as follows:

Dental Plaque - The essential requirement for the prevention and treatment of a disease is an understanding of its causes. The primary cause of gum diseases is bacteria, which form a complex on the tooth surface known as plaque. These bacteria's are the root cause of bad breath.

Dental plaque is bacterial accumulations on the teeth or other solid oral structures. When it is of sufficient thickness, it appears as a whitish, yellowish layer mainly along the gum margins on the tooth surface. Its presence can also be discerned by a conventional dye or fluorescent dye (demonstrated by illumination with ultraviolet light), disclosing solution or by scraping the tooth surface along the gum margins.

When plaque is examined under the microscope, it reveals a multitude of different types of bacteria. Some desquamated oral epithelial cells and white blood cells may also be present. The micro-organisms detected vary according to the site where they are present.

There are gram positive and gram negative organisms, filamentous and flagellated organisms, spirochetes and sometimes even small numbers of even yeasts, mycoplasma and protozoa.

Clean tooth surfaces after brushing are normally covered by a thin layer of glycoproteins from saliva called pellicle. Pellicle allows for the selective adherence of bacteria to the tooth surface.

During the first few hours, the bacteria proliferate to form colonies. In addition, other organisms will also populate the pellicle from adjacent areas to form a complex accumulation of mixed colonies. The material present between the bacteria is called intermicrobial matrix forming about 25 per cent of the plaque volume. This matrix is mainly extra cellular carbohydrate polymers produced by the bacteria from dietary sugars; salivary and gingival fluid components; and dying and dead bacteria.

Small amounts of plaque are compatible with gingival or periodontal health. Some people can resist larger amounts of plaque for long periods without developing destructive periodontitis (inflammation and destruction of the supporting tissues) although they will exhibit gingivitis (inflammation of the gums or gingiva).

Diet And Plaque Formation - Diet may play an important part in plaque formation by modifying the amount and composition of plaque. More the plaque formation would be, there will be more bad breath.

Fermentable sugars increase plaque formation because they provide additional energy supply for bacterial metabolism and also provide the raw materials (substrate) for the production of extra cellular polysaccharides.

Secondary Factors
Although plaque is the primary cause of gum diseases, a number of others regarded as secondary factors, local and systemic, predispose towards plaque accumulation or alter the response of gum tissue to plaque. The local factors are:

1) Cavities in the teeth;
2) Faulty fillings;
3) Food impaction;
4) Poorly designed partial dentures (false teeth);
5) Orthodontic appliances;
6) Misaligned teeth;
7) mouth-breathing
8) Grooves on teeth or roots near gum margins;
9) Reduced salivary flow; and,
10) Tobacco smoking.

The systemic factors which potentially affect the gum tissues are:

1) Systemic diseases, e.g. diabetes mellitus, Down's syndrome, AIDS, blood disorders and others;
2) Hormonal changes - during puberty, pregnancy, contraceptives intake and menopause;
3) Drug reactions, e.g. immunosuppressive drugs, antihypertensive drugs and antiepileptic drugs; and,
4) Dietary and nutritional factors, e.g. protein deficiency and vitamin C and B deficiency.

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