Bleeding gums 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.

Bleeding gumsBleeding gums More than 80% of adults have some More than 80% of adults have some

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

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.

Bleeding gums can be a sign that Bleeding gums can be a sign that pt are at risk for, or already have, pt are at risk for, or already have, gum disease. However, persistent gum disease. However, persistent gum bleeding may be due to gum bleeding may be due to serious medical conditions such serious medical conditions such as leukemia and bleeding and as leukemia and bleeding and platelet disorders.platelet disorders.

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

CausesCauses        Bleeding gums are mainly due to Bleeding gums are mainly due to

inadequate plaque removal from the inadequate plaque removal from the teeth at the gum line. This will lead to teeth at the gum line. This will lead to a condition called a condition called gingivitisgingivitis, or , or inflamed gums.inflamed gums.

If plaque is not removed through If plaque is not removed through regular brushing and dental regular brushing and dental appointments, it will harden into what appointments, it will harden into what is known as tartar. Ultimately, this will is known as tartar. Ultimately, this will lead to increased bleeding and a more lead to increased bleeding and a more advanced form of gum and jawbone advanced form of gum and jawbone disease known as disease known as periodontitisperiodontitis..

Other causes of bleeding gums include:Other causes of bleeding gums include: Use of blood thinners Use of blood thinners Brushing too hard Brushing too hard Improper flossing Improper flossing Infection, which can be either tooth or Infection, which can be either tooth or

gum-related gum-related ScurvyScurvy Vitamin KVitamin K deficiency deficiency Hormonal changes during pregnancy Hormonal changes during pregnancy LeukemiaLeukemia Ill-fitting dentures Ill-fitting dentures Idiopathic thrombocytopenic purpuraIdiopathic thrombocytopenic purpura

Bleeding disordersBleeding disorders DiabetesDiabetes Dry mouthDry mouth Certain medicationsCertain medications InfectionInfection Bacterial infection Bacterial infection Viral infection Viral infection Periodontal disease Periodontal disease Dental caries Dental caries Blood dyscrasias Blood dyscrasias Aplastic anaemia Aplastic anaemia Neoplastic infiltration Neoplastic infiltration Thrombocytopenia Thrombocytopenia Hemophelia Hemophelia

Bleeding gums may be due to  Bleeding gums may be due to  Injury / trauma which may be caused by a blow, Injury / trauma which may be caused by a blow,

insertion of foreign substances, tooth picking, insertion of foreign substances, tooth picking, dentures, improper brushing, flossing, etc. It may dentures, improper brushing, flossing, etc. It may also get injured from irritation of chemicals/acids in also get injured from irritation of chemicals/acids in foods, drinks, mouth fresheners, tooth whiteners and foods, drinks, mouth fresheners, tooth whiteners and medicines medicines

Disease conditions can also cause bleeding gums. Disease conditions can also cause bleeding gums. For example  For example 

Gum problems – infection of gums, retracted or Gum problems – infection of gums, retracted or receded gums, weak & spongy gums  receded gums, weak & spongy gums 

Dental problems – caries, excessive tartar/plaque Dental problems – caries, excessive tartar/plaque formation, periodontitis, etc formation, periodontitis, etc

Mouth – Mouth sores can also spread infection to Mouth – Mouth sores can also spread infection to gums to cause bleeding.  gums to cause bleeding. 

Blood disorders - Bleeding & clotting disorders - Blood disorders - Bleeding & clotting disorders - deficiency of coagulation factors, deficiency of coagulation factors, Thrombocytopenic purpura, haemophilia, Thrombocytopenic purpura, haemophilia, leukemia, etc., can cause bleeding. leukemia, etc., can cause bleeding.

Systemic – Liver disorders, kidney disorders, Systemic – Liver disorders, kidney disorders, arterial/capillary diseases, diabetes, heart arterial/capillary diseases, diabetes, heart disorders, etc., can also reflect as bleeding gums. disorders, etc., can also reflect as bleeding gums.

Nutritional and physiological – Vitamin C & K Nutritional and physiological – Vitamin C & K deficiency will lead to bleeding disorders. deficiency will lead to bleeding disorders. Pregnancy and hormonal changes can also Pregnancy and hormonal changes can also cause bleed gums occasionally. Poor oral cause bleed gums occasionally. Poor oral hygiene often causes bleeding due to infection hygiene often causes bleeding due to infection and weakness. and weakness.

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

  * Bleeding on slightest injury or even touch* Bleeding on slightest injury or even touch  * Red, tender or swollen gums* Red, tender or swollen gums * Blood with bloody taste in mouth* Blood with bloody taste in mouth  * Sometimes, due to bleeding gums,pus can be * Sometimes, due to bleeding gums,pus can be

squeezed from the gumssqueezed from the gums  * Bad breath * Bad breath * Recession of gums from the teeth* Recession of gums from the teeth * Sensitive teeth* Sensitive teeth * Loose and shaky teeth* Loose and shaky teeth Difficulty and discomfort in mastication and food Difficulty and discomfort in mastication and food

intake occasionally due to pain and intake occasionally due to pain and sensitivenesssensitiveness

For persistent bleeding gums, there are For persistent bleeding gums, there are some essential tests:some essential tests:

    * oral examination of teeth and gums * oral examination of teeth and gums     * X-rays of teeth and jaw* X-rays of teeth and jaw    * Blood analysis* Blood analysis * Tc, Dc, Esr, Hb%, sugar, calcium, urea, * Tc, Dc, Esr, Hb%, sugar, calcium, urea,

and creatinineand creatinine * Coagulation factors and serum * Coagulation factors and serum

prothrombin timeprothrombin time * Bleeding and clotting time* Bleeding and clotting time

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

Bleeding gums Bleeding gums complications complications

pt must know it is important to pt must know it is important to brush away the problem in brush away the problem in initial period itself.initial period itself.Otherwise, complications like Otherwise, complications like constant bleeding, swelling and constant bleeding, swelling and pain in gums, periodontal pain in gums, periodontal disease, jaw bone disease, and disease, jaw bone disease, and finally tooth loss can occur.finally tooth loss can occur.

General treatment of bleeding gumsGeneral treatment of bleeding gums To keep healthy and smiling teeth, it is essential To keep healthy and smiling teeth, it is essential

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

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

Therefore, treatment of bleeding gums locally with Therefore, treatment of bleeding gums locally with this type of gum gel will not help in the long run. We this type of gum gel will not help in the long run. We should always aim at treating the cause and should always aim at treating the cause and symptoms internally with internal medicines for symptoms internally with internal medicines for reviving complete cure reviving complete cure

Soft bristle tooth brushes to brush Soft bristle tooth brushes to brush gently Vitamin supplements in case of gently Vitamin supplements in case of deficiency Take care for Well balanced deficiency Take care for Well balanced

nutritious dietnutritious dietProper mastication Brush away the Proper mastication Brush away the food particles in mouth after every food particles in mouth after every

meal Propermeal Properbrushing i.e. gentle and careful. Ill-brushing i.e. gentle and careful. Ill-

fittingfittingdentures if any .Oral hygiene and dentures if any .Oral hygiene and

dental health .Gargle with salty warm dental health .Gargle with salty warm water afterwater after

every mealevery meal

Bleeding gums preventionBleeding gums prevention Everyone who want to prevent bleeding gums should avoid Everyone who want to prevent bleeding gums should avoid

hard and fast brushing, hard diets and snacks which can hard and fast brushing, hard diets and snacks which can cause injury such as cause injury such as chips, sour foods or drinks, hot drinks, chips, sour foods or drinks, hot drinks, carbonated acid drinks, sticky chocolates, pain-killers, carbonated acid drinks, sticky chocolates, pain-killers, blood thinners and unnecessary medicationblood thinners and unnecessary medication. pt should rinse . pt should rinse mouth with mouth fresheners often. Tobacco chewing, betel mouth with mouth fresheners often. Tobacco chewing, betel nut chewing and smoking is something that pt should also nut chewing and smoking is something that pt should also avoid. Take care of plaque deposits by proper cleaning and avoid. Take care of plaque deposits by proper cleaning and visiting dentist regularly. Use soft bristle toothbrushes to visiting dentist regularly. Use soft bristle toothbrushes to brush gently and use vitamin supplements in case of brush gently and use vitamin supplements in case of deficiency. Use well-balanced nutritious diet, proper deficiency. Use well-balanced nutritious diet, proper mastication, and brush away the food particles in the mouth mastication, and brush away the food particles in the mouth after every meal. Oral hygiene and dental health is very after every meal. Oral hygiene and dental health is very important as well. Try to gargle with salty warm water after important as well. Try to gargle with salty warm water after every meal every meal

INTRODUCTION OF DANTA ACCORDING TO INTRODUCTION OF DANTA ACCORDING TO AYURVEDA AYURVEDA

Danta i.e. tooth is also known as Danta i.e. tooth is also known as “Ruchakasthi” and is a variety of bony “Ruchakasthi” and is a variety of bony tissue. The word “Ruchaka” means that tissue. The word “Ruchaka” means that which imparts taste and “asthi”means which imparts taste and “asthi”means bone.bone.

There are 32 permanent teeth and 24 There are 32 permanent teeth and 24 deciduous teeth. It appears that over 5000 deciduous teeth. It appears that over 5000 years since the time of kashyap, children years since the time of kashyap, children of have lost 4of their deciduous teeth and of have lost 4of their deciduous teeth and at present only 20 deciduous teeth are at present only 20 deciduous teeth are present .even many adults at present present .even many adults at present either do not have their wisdom teeth or either do not have their wisdom teeth or they are very much underdeveloped. they are very much underdeveloped. Hence the number of permanent teeth Hence the number of permanent teeth

usually present in adults varies from 28 to usually present in adults varies from 28 to 32 32

The time taken for the eruption of a teeth is the same The time taken for the eruption of a teeth is the same number in terms of days as the month in which the number in terms of days as the month in which the tooth erupted ,eg if the central incisor erupts in the tooth erupted ,eg if the central incisor erupts in the sixth month it will take 6 days for complete eruption. sixth month it will take 6 days for complete eruption. the primary teeth will fall in the same year as the the primary teeth will fall in the same year as the month, at which it erupted.month, at which it erupted.

The central incisiors,the lateral incisors ,the cannines The central incisiors,the lateral incisors ,the cannines and the molars are called as Rajadanta, Vasta,Danshtra and the molars are called as Rajadanta, Vasta,Danshtra and Hanavya respectively . There are 2 each of and Hanavya respectively . There are 2 each of rajdanta, Vasta and Danshtra and 6 of Hanavya in each rajdanta, Vasta and Danshtra and 6 of Hanavya in each upper as well as lower jaw.The bony tissue as well as upper as well as lower jaw.The bony tissue as well as the bone marrow are the primary tissues from which the bone marrow are the primary tissues from which the tissue develop.the tissue develop.

NORMAL TEETH AND GUMSNormal 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.

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

DISEASE SYNONYMS DOSHAS AFFECTED

ABNORMALITY OF GUMS

1. Samvruta-danta2. vivruta-danta

1.Hypertrophy of gums2.atrophy of gums

*TRAUMATIC3.Dantavaidarbha

Injury to gums

*DOSHAJANA

4.Adhimansa Pericoronitis of wisdom teeth

Kaphaja

5.Dantaveshtha Chronic suppurative gingivitis

raktaja

6.Upakusha Recurrent acute suppurative gingivitis

Pitaj +raktaja

7.Sheetada Chronic suppurative recessive gingivitis

Kafaj+raktaj

8.Soushira Suppurative periodontitis

Kaphaj+rakataj

9.Mahasoushira Necrotising ulcerative gingivo-stomatitis

Tridoshaj

10.Paridara Atrophic gingivitis Tridoshaj

11.Dantavidaran Alveolar abscess with sinus

Tridoshaj

12.Dantapupputak Periodontal abscess

Kaphaj+rakataj

13.Dantavidradhi Alveolar abscess

Tridoshaj+raktaj

14.Dantamans arbuda

Tumors of gums

Tridoshaj+kaphaj

15.Dantmansasruk Bleeding from gums

Raktaj +pitta

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

*Katunimb

ACCORDING TO PRAKRUTI LIST OF PLANT WHICH SHOULD BE USED FOR DANTDHAWAN

ConstitutionCharacteristics

of gumsStem 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

TOOTH POWDER

TriphalaTrijataka

With honey and saindhav for kapha and pitta constitution.

Trikatu With honey and saindhav for kapha constitution.

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.