An untreated inflammation in the gums can eventually lead to periodontitis. Yet, many people overlook the symptoms of gingivitis, as it is also called. Here are the signs you should be on the lookout for - and the best tips for healthy gums.

Plaque, the bacterial buildup on teeth, causes 95 percent of all oral diseases. Gingivitis is no exception.

- Gingivitis is an inflammation that affects the dental tissue, i.e., the gums. It occurs because the harmful bacteria that we all have in our mouths have not been sufficiently removed, allowing them to grow, says Ing-Marie Albinsson, a dental hygienist at the Lilla Tandkronan clinic in Arvika.

The immune system responds to the bacteria by sending more white blood cells to the area. Blood flow increases, causing the gums to swell.

- Unfortunately, in this case, it has a somewhat undesired effect. The bacteria that caused the inflammation thrive especially well in an oxygen-poor environment, and protected by the swollen gums, they can grow even more, says Ing-Marie Albinsson.

The first sign of gingivitis is thus swollen gums, something that is not always easy to detect. The next step is that the gums become even more inflamed and start bleeding. At first, it occurs infrequently, but gradually more often and due to lighter strains.

- If it bleeds every time you brush your teeth or, for example, bite into an apple, then the inflammation has progressed relatively far, says Ing-Marie Albinsson.

Choose the right tool

The most important step to combat gingivitis is cleaning - both on and between the teeth.

- With the toothbrush, you only reach the free surfaces, such as the outside, inside, and chewing surfaces. But between the teeth, we need to use other tools, such as interdental brushes or dental floss, says Albinsson.

The choice of tool depends on the size of the gaps between the teeth. And how to use it is just as crucial.

- A large part of our treatment for patients with advanced gingivitis is education by the dental hygienist. If you don't use the right tool correctly, the effect is lacking, says Albinsson.

Dual Light treatment is effective

Succeeding in the treatment of gingivitis is incredibly important - because if it is not done, the consequences can be serious.

- If the bacteria continue to grow, they begin to grow downward, which can create deep pockets. Through them, the bacteria can eventually also reach the threads holding the teeth and attack them. This leads to periodontitis, says Albinsson.

To avoid this, Ing-Marie recommends a complementary treatment with the Finnish innovation Lumoral, which removes 99.9 percent of the harmful bacteria in our mouths through a patented light treatment. 

- When we brush our teeth, 65 percent of the bacteria disappear. With Lumoral, you get a completely different result. The method is easy to use and is especially effective for those who already have problems. But it can also be used preventively, both to stay healthy and to reduce the costs of future dental care, says Albinsson.

This is Lumoral

The Lumoral method removes microscopic plaque from the surface of teeth and gums, slows down the formation of new plaque, and delays the onset of tartar. Its effect is based on the light-activated Lumorinse mouthrinse. The treatment targets its antibacterial effect only on plaque and thus benefits the normal bacterial flora in the mouth. Lumoral is a CE-marked medical device.

Lumoral consists of a mint-flavored mouthrinse, Lumorinse, used in combination with the special mouthpiece. The treatment eliminates the ability of plaque to stick to the surfaces of teeth so that teeth become clean and teeth surfaces  smooth.

The at-home treatment takes 10 minutes and is recommended once or twice a week.

Lumoral Junior

For children, there is Lumoral Junior. The Lumoral Junior mouthpiece is suitable for children between 4 and 12 years old. From the age of 12, the Lumoral mouthpiece for adults is generally suitable for a child to use. To use Lumoral, the child should be able to rinse his or her mouth with a mouthrinse.

(This article is based on the writing of dentist Viktoria Ljutkina, published in the largest dental medicine periodical in Estonia, Ajakiri Hambaarst. Ljutkina works as a dentist at Läänemere Hambakliinikus dental clinic in Tallinn.)

Periodontitis is a common disease affecting an estimated 20–50% of the population. This severe oral condition originates in the gum tissue, and if left untreated, the inflammatory process spreads deeper, leading to tooth loss (1). Periodontitis is a multifactorial disease primarily caused by bacterial colonization in the oral cavity (2). Many risk factors, such as diabetes and smoking, contribute to the development of periodontitis and influence its prognosis.

The goal of periodontitis treatment is to eliminate factors promoting inflammation in the oral cavity and support the patient's immune system. Fundamental to gum disease treatment is meticulous oral hygiene, preventing the formation of new dental calculus and reducing the number of bacteria in the oral cavity, thereby promoting periodontitis healing (3). The effects of Antimicrobial Photodynamic Therapy (aPDT) on oral diseases, including periodontitis and peri-implantitis, have been extensively studied, with substantial clinical evidence supporting its effectiveness.

The Lumoral oral care method, developed by Finnish scientists, is based on dual-light antibacterial therapy that can be administered at home. Lumoral's effects have been scientifically proven in various clinical studies. Regular use of Lumoral prevents tooth decay and significantly reduces the count of periodontal bacteria in the mouth (4).

Lumoral treatment relies on the administration of dual-light therapy through the Lumoral oral device – near-infrared light and antibacterial blue light. The near-infrared light has a wavelength of 810 nm, penetrating tissues up to 10 cm deep. Antibacterial blue light, with a wavelength of 410 nm, acts on inflammation-causing bacteria, slowing down their growth. When porphyrin molecules in the bacteria are exposed to specific wavelengths of light, they produce reactive oxygen species, which, in turn, kill the bacteria.

Lumoral is effective against harmful bacteria in the mouth

The Lumoral method includes a light source and a mouthwash. The photosensitive indocyanine green molecule in the Lumorinse mouthwash, in combination with the light source, achieves the desired therapeutic outcome. Indocyanine green (ICG) is water-soluble and highly light-absorbing. The dual light reacts with the ICG photosensitizer, generating reactive oxygen species (ROS) and heat, initiating a series of photochemical and biological processes that destroy the bacterial cell membrane, thereby damaging the bacterial cell structure.

The body's immune cells use a similar method to protect against harmful pathogens. Pathogenic bacteria contain porphyrin and flavin molecules with photosensitive properties. Therefore, Lumoral mainly affects pathogenic bacteria.

The Lumoral method has proven to be highly effective against harmful bacteria, with no development of bacterial resistance even with repeated use (5). The largest European study on periodontitis demonstrates significant improvement in treatment outcomes when dental calculus is regularly removed from the mouth. Lumoral has been shown to help users achieve better oral hygiene, even after using the most modern and efficient electric toothbrushes, which can leave plaque on teeth. The study also indicates that Lumoral aids in achieving better oral hygiene.

In support of brushing and flossing

Lumoral does not replace the need for mechanical brushing and cleaning between teeth but helps further improve oral hygiene. Effectively, Lumoral can remove bacteria from the surfaces of teeth and even from the gumline, where access with a toothbrush may be challenging.

aPDT treatment has proven to be significantly more effective and better tolerated than commonly used chlorhexidine mouthwashes. Home use of Lumoral reduces gum inflammation and enhances oral hygiene. Effective oral hygiene also enhances the efficiency of periodontal treatment (6).

Periodontal treatment and improvement of oral hygiene are considered the gold standard in periodontitis treatment. However, some patients may not respond positively to treatment due to risk factors and/or systemic diseases.

Smoking is considered a major risk factor for gum diseases, negatively impacting both the course of the disease and treatment outcomes. Nicotine in tobacco products hinders the oral cavity's defense mechanisms, impedes the healing of periodontal tissues, and adversely affects tissue blood circulation. Changes in the oral microbiome also occur due to smoking, promoting the development of advanced periodontitis and poorer healing after treatment. Finding effective treatment for smoking patients with periodontitis is crucial because managing periodontitis based on the aforementioned biological processes poses a significant challenge for physicians (7).

Independent Lumoral study shows efficacy

I decided to try the Lumoral method at Läänemere Hambakliinikus dental clinic to improve oral hygiene in patients with periodontitis. Twelve smoking patients with generalized periodontitis at stage III, grade B, and without other chronic diseases were selected for the clinical study. Half of the patients received Lumoral photodynamic therapy 2–3 times a week for six months (recommended dose after periodontal treatment twice daily for four weeks). The remaining patients received traditional periodontal treatment only. The general treatment strategy was similar for all patients, including comprehensive diagnostics (periodontal condition, radiological diagnostics, anamnesis), non-surgical periodontal treatment, and periodontal follow-ups at two weeks, three months, and six months. During the control visits, patients' dental calculus was stained to check oral hygiene.

I noticed that patients using Lumoral in addition to traditional treatment showed better results in periodontal treatment outcomes (pocket depths, tooth mobility, BOP, VIP, SUP) and oral hygiene compared to those not using Lumoral as an oral hygiene aid. Based on my clinical experience, we can conclude that using the Lumoral method improves patients' oral hygiene and leads to more positive treatment outcomes. It is essential to use the device correctly and regularly following the dentist's recommendations.

References:

Petersen, P. E., Baehni, P. C. Periodontal health and global public health. Periodontol 2000. 2012 Oct; 60 (1): 7–14.

Bartold, P. M., Van Dyke, T. E. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000. 2013 Jun; 62 (1): 203–17.

Greenstein, G. Research, Science and Therapy Committee of the American Academy of Periodontology. The Role of supra- and subgingival irrigation in the treatment of periodontal diseases. J Periodontol. 2005; 76: 2015–27.

Villafuerte, K. R., Martinez, C. J. H., Vieira, L. H. P., Nobre, A. V. Benefits of antimicrobial photodynamic therapy as an adjunct to non-surgical periodontal treatment in smokers with periodontitis: a systematic review and meta-analysis. Medicina 2023, 59 (4): 684.

Lähteenmäki, H., Pätilä, T., Räisänen, I. T., Kankuri, E., Tervahartiala, T., Sorsa, T. Repeated Homeapplied dual-light antibacterial photodynamis therapy can reduce

Good oral hygiene is an essential part of the basic management of kidney and liver disease. For transplant patients, oral health care is particularly important as these patients are often at increased risk of oral infections and their complications.

The health of the kidneys and liver is closely linked to the well-being of the whole body, and oral health also affects the functioning of these organs. Poor oral health can increase the body's risk of inflammation and reduce overall immunity. This in turn can negatively affect the management of kidney and liver diseases (1).

- Kidney and liver diseases and their treatments are often associated with a weakening of the body's defence mechanisms, which can make any infection dangerous. This is especially true if patients are prescribed immunosuppressive medication, as is always the case after transplantation, says Jukka Meurman, Professor Emeritus, Department of Oral and Maxillofacial Diseases, Helsinki University Hospital.

Inflamed gums provide a direct route for bacteria in the mouth to enter the rest of the body.

- From the mouth and teeth, bacteria can easily enter the bloodstream through gingivitis, periodontitis, caries cavities, and mucosal ulcers. Infections of the mouth are harmful because they result in a low-grade inflammatory condition, at worst involving the whole body, Meurman continues.

Oral infections are particularly harmful for chronically ill people - including diabetics, people with rheumatic and kidney diseases, and patients on immunosuppressive medication, or with defence system disorders. Recent research suggests that dental infections may even increase the risk of cancer (2, 3)

- This is also explained by chronic inflammation, says Meurman.

Preventing the risk of bacteraemia

The risk of bacteraemia is increased in people with long-term conditions. Bacteraemia is an infection caused by bacteria, which occurs when bacteria that have entered the bloodstream trigger the body's defence response against them. In the worst cases, it can trigger damage to one or more organs. This is called sepsis. (4)

Bacteria can enter the bloodstream from inflamed areas of the oral cavity. This can happen during tooth brushing, flossing, or dental procedures. In most cases, bacteraemia is short-lived, and the body can fight it off. However, if a person has a weakened immune system or if bacteraemia recurs frequently, it can cause problems.

- In chronically ill patients, every effort should be made to prevent bacteraemia. Oral health is crucial, as the mouth is the most common source of normal bacterial growth in the body.  Mucous membranes, teeth, and gums must be kept in healthy condition through daily effective oral hygiene maintenance, says Meurman.

Studies have shown that in patients at risk of heart disease, bacteraemia caused by dental procedures is even one of the causes of bacterial endocarditis. Bacterial endocarditis is an infection that affects the endocardium, the inner membrane of the heart, and can be particularly serious in people with compromised immunity. This infection can damage the heart valves and requires immediate treatment (5).

Aiming for an infection-free mouth

At the time of transplantation, the teeth and mouth must be healthy and free of infection.  Oral health also has an impact on recovery from surgery. Meurman points out that transplant patients are at risk of infection for the rest of their lives, so it is essential that they strive to maintain good oral hygiene every day.

- All available methods should be put in place well in advance of any surgery.

Oral infections and the resulting distant infections can be fatal for surgical and chronically ill patients.

- All oral and dental infections should be diagnosed and treated before transplant surgery. This often involves extraction of infected teeth with poor prognosis.  For example, those with deep cavities or deep periodontal pockets need to be removed.

However, radical solutions are not always necessary before surgery. A transplant patient's treatment plan is individual and influenced by the patient's own motivation to maintain good oral health. On the other hand, if the transplant is not planned for many years, more tooth-preserving and restorative treatments are  possible. In this case, tooth extractions can be avoided.

- The basic idea is, of course, that the mouth and teeth should have been always kept in good condition by careful and regular oral hygiene practices, rather than reacting only when there is a need for radical treatments, says Meurman.

Deep gum pockets are nests of bacteria

In addition to health and general well-being, maintaining good oral health also affects the patient's quality of life. A painful mouth, dental problems and other oral health issues can reduce a patient's quality of life and increase stress, which in turn can have a negative impact on health in general and the outcome of treatment for an underlying disease, says Meurman.

Regular dental check-ups and careful oral hygiene practices are an important part of comprehensive health care for people with kidney and liver diseases.

Taking care of oral health and working closely with dental professionals is particularly important for patients taking immunosuppressive drugs, which increase the risk of oral infections such as gingivitis and periodontitis. This is because these drugs weaken the immune system's ability to fight bacteria in the mouth.

Immunosuppressive medicines can also cause changes to the mucous membranes, such as mouth ulcers and dryness (xerostomia), which increases the risk of caries.

Periodontal disease – a persistent companion once it breaks out

Signs of periodontal disease include reddened and bleeding gums and bad breath. In people with periodontal disease, the fibres that attach to the tooth are destroyed. A pocket begins to form between the gum and the tooth, which can extend around the entire tooth. Gradually, the inflammation begins to destroy more of the tissues that attach the teeth and eventually spread in the jawbone.

Once established, periodontitis is a tenacious companion that will progress if not treated carefully. Daily oral home care plays an important role in periodontitis and  oral health in general.

- Regular dental check-ups, daily brushing and cleaning of the interdental spaces and maintaining the oral moisture balance are important measures to maintain oral health.

However, traditional oral hygiene methods are not always enough to keep the mouth healthy. For example, flossing or brushing may be difficult due to age, thus leaving the spaces between the teeth uncleaned. On the other hand, even if brushing the teeth is successful, studies have shown that even an effective electric toothbrush only removes about 65% of the harmful bacteria in the mouth. (6)

To tackle this residual plaque, which is invisible to the naked eye, Finnish researchers have developed an antibacterial oral health enhancing device that is based on antibacterial photodynamic therapy. This method effectively eliminates both the bacteria responsible for tooth decay and those contributing to gingivitis. The Finnish Association of Oral Hygienists has endorsed the use of the Lumoral device (7).

- Home-administered antibacterial photodynamic therapy is a new method that helps improve oral health and has been proven to be effective in scientific studies. It does not replace other oral hygiene methods such as tooth brushing and flossing but complements them perfectly. For liver, kidney, and organ transplant patients, if any, use of the new method is highly recommended, says Meurman.

The oral health enhancing device is used in addition to regular brushing. Plaque, which is made up of living bacterial cells, is normally sticky and is difficult to remove completely from the surfaces of the teeth with a brush alone. After using the device, the existing plaque becomes easier to remove by brushing (8).

- Home-administered antibacterial photodynamic therapy is suitable for everyone but is particularly important for those with tooth decay or gingivitis.

Prof Jukka Meurman is an eminent figure in the field of oral infectious diseases. Presently, he holds the title of Professor Emeritus at the University of Helsinki, and serves as the Head Physician at the Department of Oral and Maxillofacial Diseases at Helsinki University Hospital, Finland. His contributions have earned him numerous prestigious honors and accolades.

Sources:

1.       Åberg F, Helenius-Hietala J. Oral Health and Liver Disease: Bidirectional Associations-A Narrative Review. Dent J (Basel). 2022 Jan 21;10(2):16. doi: 10.3390/dj10020016. PMID: 35200242; PMCID: PMC8870998..
2.       Nieminen, M., Listyarifah, D., Hagström, J. et al. Treponema denticola chymotrypsin-like proteinase may contribute to orodigestive carcinogenesis through immunomodulation. Br J Cancer 118, 428–434 (2018). https://doi.org/10.1038/bjc.2017.409
3.       Heikkilä, P., But, A., Sorsa, T. and Haukka, J. (2018), Periodontitis and cancer mortality: Register-based cohort study of 68,273 adults in 10-year follow-up. Int. J. Cancer, 142: 2244-2253. https://doi.org/10.1002/ijc.31254
4.       https://www.epressi.com/tiedotteet/terveys/suun-infektiopesakkeet-voivat-vaarantaa-syopa-tai-leikkauspotilaan-hoidon.html
5.       Poveda-Roda R, Jiménez Y, Carbonell E, Gavaldá C, Margaix-Muñoz MM, Sarrión-Pérez G. Bacteremia originating in the oral cavity. A review. Med Oral Patol Oral Cir Bucal. 2008 Jun 1;13(6):E355-62. PMID: 18521055.
6.       Aggarwal N, Gupta S, Grover R, Sadana G, Bansal K. Plaque removal efficacy of different toothbrushes: a comparative study. Int J Clin Pediatr Dent. 2019;12(5):385-390. doi:10.5005/jp-journals-10005-1669
7.       The Finnish Oral Hygiene Association recommends Lumoral. Finnish Association of Dental Hygienists. September 1, 2022. https://www.suuhygienistiliitto.fi/suomen-suuhygienistiliitto-suosittelee-lumoralia/
8.       Pakarinen, Saila, et al. "Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results." Dentistry Journal 10.11 (2022): 206.