BLEEDING GUMS

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BLEEDING GUMS
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INTRODUCTION
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• Bleeding gums
• More than 80 of adults have some form of
  periodontal disease and 99 of those have no
  signs to indicate they have a problem. patient's
  mouth is a portal to patient's body. More than
  90 of all systemic diseases have oral
  manifestations! When pt research the problem of
  bleeding gums, pt will quickly realize that
  EVERYONE has a toothpaste solution to this
  problem.

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Tooth anatomy
The structure of the tooth includes dentin, pulp
and other tissues, blood vessels and nerves
imbedded in the bony jaw. Above the gum line, the
tooth is protected by the hard enamel covering.
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• Bleeding gums can be a sign that pt are at risk
  for, or already have, gum disease. However,
  persistent gum bleeding may be due to serious
  medical conditions such as leukemia and bleeding
  and platelet disorders.

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• INCIDENCES Bleeding gums is more commonly seen in
  adults. In case of children, it is mostly due to
  injury due to improper brushing. In case of
  adults or the aged, it is often found to be
  related with disease. Females have higher
  incidences than males. Marginal gingivitis is
  most common i.e. bleeding from gums comes usually
  from / near the base of the teeth.

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CAUSES
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• Causes   
• Bleeding gums are mainly due to inadequate plaque
  removal from the teeth at the gum line. This will
  lead to a condition called gingivitis, or
  inflamed gums.
• If plaque is not removed through regular brushing
  and dental appointments, it will harden into what
  is known as tartar. Ultimately, this will lead to
  increased bleeding and a more advanced form of
  gum and jawbone disease known as periodontitis.

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• Other causes of bleeding gums include
• Use of blood thinners
• Brushing too hard
• Improper flossing
• Infection, which can be either tooth or
  gum-related
• Scurvy
• Vitamin K deficiency
• Hormonal changes during pregnancy
• Leukemia
• Ill-fitting dentures
• Idiopathic thrombocytopenic purpura

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• Bleeding disorders
• Diabetes
• Dry mouth
• Certain medications
• Infection
• Bacterial infection
• Viral infection
• Periodontal disease
• Dental caries
• Blood dyscrasias
• Aplastic anaemia
• Neoplastic infiltration
• Thrombocytopenia
• Hemophelia

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• Bleeding gums may be due to 
• Injury / trauma which may be caused by a blow,
  insertion of foreign substances, tooth picking,
  dentures, improper brushing, flossing, etc. It
  may also get injured from irritation of
  chemicals/acids in foods, drinks, mouth
  fresheners, tooth whiteners and medicines
• Disease conditions can also cause bleeding gums.
  For example 
• Gum problems infection of gums, retracted or
  receded gums, weak spongy gums 
• Dental problems caries, excessive tartar/plaque
  formation, periodontitis, etc
• Mouth Mouth sores can also spread infection to
  gums to cause bleeding. 

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• Blood disorders - Bleeding clotting disorders -
  deficiency of coagulation factors,
  Thrombocytopenic purpura, haemophilia, leukemia,
  etc., can cause bleeding.
• Systemic Liver disorders, kidney disorders,
  arterial/capillary diseases, diabetes, heart
  disorders, etc., can also reflect as bleeding
  gums.
• Nutritional and physiological Vitamin C K
  deficiency will lead to bleeding disorders.
  Pregnancy and hormonal changes can also cause
  bleed gums occasionally. Poor oral hygiene often
  causes bleeding due to infection and weakness.

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• PATHOPHYSIOLOGY - Infection (bacterial / viral /
  fungal) arises in the gums and teeth produce
  acids and toxins which usually erode and cause
  inflammation of the gums. The inflammation makes
  gums swollen, red and spongy which increases the
  tendency to bleed and weakens the stability of
  the teeth by recession. 

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SYMPTOMS
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•   Bleeding on slightest injury or even
  touch
•   Red, tender or swollen gums
• Blood with bloody taste in mouth
•   Sometimes, due to bleeding gums,pus can be
  squeezed from the gums
•   Bad breath
• Recession of gums from the teeth
• Sensitive teeth
• Loose and shaky teeth
• Difficulty and discomfort in mastication and
  food intake occasionally due to pain and
  sensitiveness

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DIAGNOSING BLEEDING GUMS
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• For persistent bleeding gums, there are some
  essential tests
•   oral examination of teeth and gums
•   X-rays of teeth and jaw
•   Blood analysis
• Tc, Dc, Esr, Hb, sugar, calcium, urea, and
  creatinine
• Coagulation factors and serum prothrombin
  time
• Bleeding and clotting time

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Gingivitis
Inflammation of the gums is called gingivitis.
Bacteria in plaque around the teeth release
enzymes (collagenases) that can damage and erode
the gum tissues. The infected gums swell, bleed
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• Bleeding gums complications
• pt must know it is important to brush away the
  problem in initial period itself.Otherwise,
  complications like constant bleeding, swelling
  and pain in gums, periodontal disease, jaw bone
  disease, and finally tooth loss can occur.

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TREATMENT
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• General treatment of bleeding gums
• To keep healthy and smiling teeth, it is
  essential to keep the gums healthy. The first and
  best treatment is maintaining oral and dental
  hygiene. Do it with proper brushing techniques.
  Due to a wide range of problems occurring in the
  gums and teeth, most of the patients are
  prescribed antibiotics and varieties of paste to
  control infection.. For complete cure, treatment
  should be started at the early stage otherwise,
  the gums may recede or shrink, paving way for
  infection to enter the base of the teeth to
  loosen it.

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• Once gums get retracted and receded, gaining
  normalcy is tough, but even though we make gums
  healthy by treatment, it will not adhere to the
  teeth as tightly as before. In that case, the
  cementum of the teeth will be exposed to cause
  sensitive teeth. Therefore, treating bleeding
  gums earlier is a must. Usually, pain is always
  preferable to numbness, where some people go for
  benumbing the gum with gum gel for pain relief
  and arresting the bleeding. It will work only
  temporarily and in this case, the disease often
  advances further, causing more and more pain and
  more and more complications, since this type of
  temporary alleviating maneuver always allow the
  disease in the track with temporary
  hurdle.Therefore, treatment of bleeding gums
  locally with this type of gum gel will not help
  in the long run. We should always aim at treating
  the cause and symptoms internally with internal
  medicines for reviving complete cure

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Soft bristle tooth brushes to brush gently
Vitamin supplements in case of deficiency Take
care for Well balanced nutritious dietProper
mastication Brush away the food particles in
mouth after every meal Properbrushing i.e.
gentle and careful. Ill-fittingdentures if any
.Oral hygiene and dental health .Gargle with
salty warm water afterevery meal
USE
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• Bleeding gums prevention
• Everyone who want to prevent bleeding gums
  should avoid hard and fast brushing, hard diets
  and snacks which can cause injury such as chips,
  sour foods or drinks, hot drinks, carbonated acid
  drinks, sticky chocolates, pain-killers, blood
  thinners and unnecessary medication. pt should
  rinse mouth with mouth fresheners often. Tobacco
  chewing, betel nut chewing and smoking is
  something that pt should also avoid. Take care of
  plaque deposits by proper cleaning and visiting
  dentist regularly. Use soft bristle toothbrushes
  to brush gently and use vitamin supplements in
  case of deficiency. Use well-balanced nutritious
  diet, proper mastication, and brush away the food
  particles in the mouth after every meal. Oral
  hygiene and dental health is very important as
  well. Try to gargle with salty warm water after
  every meal

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DANTMANSASRUK
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• INTRODUCTION OF DANTA ACCORDING TO AYURVEDA
• Danta i.e. tooth is also known as Ruchakasthi
  and is a variety of bony tissue. The word
  Ruchaka means that which imparts taste and
  asthimeans bone.
• There are 32 permanent teeth and 24 deciduous
  teeth. It appears that over 5000 years since the
  time of kashyap, children of have lost 4of their
  deciduous teeth and at present only 20 deciduous
  teeth are present .even many adults at present
  either do not have their wisdom teeth or they are
  very much underdeveloped. Hence the number of
  permanent teeth
• usually present in adults varies from 28 to 32

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• The time taken for the eruption of a teeth is the
  same number in terms of days as the month in
  which the tooth erupted ,eg if the central
  incisor erupts in the sixth month it will take 6
  days for complete eruption. the primary teeth
  will fall in the same year as the month, at which
  it erupted.
• The central incisiors,the lateral incisors ,the
  cannines and the molars are called as Rajadanta,
  Vasta,Danshtra and Hanavya respectively . There
  are 2 each of rajdanta, Vasta and Danshtra and 6
  of Hanavya in each upper as well as lower jaw.The
  bony tissue as well as the bone marrow are the
  primary tissues from which the tissue develop.

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• NORMAL TEETH AND GUMS
• Normal healthy teeth are strong ,white ,dense ,
  smooth , clean ,slightly ,prominent, well
  developed and evenly placed in relation to each
  other. They do not decay and are not affected by
  disease. The gums are even ,pink , smooth ,dense,
  and steady. Gums are known as Dantamansa or
  Dantaveshta . Thus diet and tonics good for bony
  and muscular tissue are useful for teeth and gums
  respectively.

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According to Sushrut there are 15 diseases of the
roots of teeth and gums. However ,Yogratnakar and
vaghbhat has included 1more (Dantavidradhi)as the
sixteenth disease.Apart from this Madhavnidana
has given reference of karala,thus increasing the
number to 17.Now lets discuss some of them in
brief
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DISEASE SYNONYMS DOSHAS AFFECTED
ABNORMALITY OF GUMS Samvruta-danta vivruta-danta 1.Hypertrophy of gums 2.atrophy of gums
TRAUMATIC 3.Dantavaidarbha Injury to gums
DOSHAJANA
4.Adhimansa Pericoronitis of wisdom teeth Kaphaja
5.Dantaveshtha Chronic suppurative gingivitis raktaja
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6.Upakusha Recurrent acute suppurative gingivitis Pitaj raktaja
7.Sheetada Chronic suppurative recessive gingivitis Kafajraktaj
8.Soushira Suppurative periodontitis Kaphajrakataj
9.Mahasoushira Necrotising ulcerative gingivo-stomatitis Tridoshaj
10.Paridara Atrophic gingivitis Tridoshaj
11.Dantavidaran Alveolar abscess with sinus Tridoshaj
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12.Dantapupputak Periodontal abscess Kaphajrakataj
13.Dantavidradhi Alveolar abscess Tridoshajraktaj
14.Dantamans arbuda Tumors of gums Tridoshajkaphaj
15.Dantmansasruk Bleeding from gums Raktaj pitta
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HEALTH AND HYGIENE OF TEETH Each teeth should be
brushed individually by koorchaka i.e, a soft
tooth brush .the brush should be rotated over
gums and the teeth in the vertical manner i.e
from below upwards in the lower jaw and from
above downward in the upper jaw .Side to side
brushing must be avoided, as it may damage the
necks of the teeth and also the gums .one should
rinse and gargle the mouth after brushing the
teeth as well as after eating any food . A
soft brush can be made by bitting and chewing the
tips of fresh stem of the following plants
Arka Nyagrodha Khadir Karanja Arjuna Katu
nimb
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CHIKITSA
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ACCORDING TO PRAKRUTI LIST OF PLANT WHICH
SHOULD BE USED FOR DANTDHAWAN
Constitution Characteristics of gums Stem indicated Taste
Vata Thin, atrophic, dry and rough Glycerrhiza Khadira Madhur
Pitta Spongy,inflamm and red Nimba Arjun Tikta
Kapha Hypertrophic and whitish Karanja Arka Katu
Rakta-Pitta Bleeding and spongy gums khadira Kashaya
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TOOTH POWDER
Triphala Trijataka With honey and saindhav for kapha and pitta constitution.
Trikatu With honey and saindhav for kapha constitution.
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DIET HARMFUL FOR GUMS Pungent and salty food ,
drumstick, Chana ,Bringal, fish and raw mango are
harmful for gums.Curds ,Til, Mustard ,Chilly
Garlic ,fermented food items,Jaggery,Alcoholic
prepration and incompatible diet should be
avoided.Also person suffering from bleeding gums
should avoid exposure to sun ,exercise traveling
,induction of sweating,sexual intercourse,
smoking and brushing teeth .Cold environment has
beneficial effects in this condition.
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COMPILED BY ARJITA KUMARI