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New Aspects of Gingivitis and the Body

August 16, 2021

Why do some people gums bleed more than others, or lose more bone around teeth than others?

Recent studies for the first time have found and categorised the different responses people have to the build-up of dental plaque

Plaque on the surface of teeth consists of bacteria, salivary proteins, bacterial products that make it a sticky biofilm.

Large amount of plaque near gum - bad breath city!

The studies were published in the journal Proceedings of the National Academy of Sciences (PNAS).  There is new information on why some people may be more prone to serious conditions comprise teeth and lead to other issues.

Researchers, led by a team at the University of Washington School of Dentistry, also found a previously unidentified range of inflammatory responses to bacterial build up in the mouth.


When bacteria  build up on tooth surfaces, it generates inflammation, which is the first step to an immune response by the body. What happens with inflammation is that the blood vessels in gums near the plaque start to leak fluid. This leakage contains immune cells and products to fight the irritating bacteria and the products that they produce.

Previously, there were two known major oral inflammation phenotypes: a high or strong clinical response and a low clinical response. The team identified a third phenotype, which they called “slow”: a delayed strong inflammatory response in the wake of the bacterial build-up.

The study revealed for the first time that people with low clinical response also demonstrated a low inflammatory response for a wide variety of inflammation signals.

Therefore understanding the variations in gum inflammation could help better identify people at elevated risk of periodontitis. Periodontitis is the inflammation of not only the gums but the ligament that holds the tooth to the bone, as well as the adjacent bone.

X-ray - XS bone loss on lower front teeth with calculus on root

Also, this variation in the inflammatory response among people may be related to susceptibility to other chronic bacterial-associated inflammatory conditions such as inflammatory bowel disease.


The protective response by the body, triggered by plaque accumulation, is there to save tissue and bone during inflammation. This mechanism, which was apparent among all three phenotypes, or responses, utilises white blood cells known as neutrophils. These cells are the first line of the immune response but they also regulate the bacterial population to maintain a stable condition known as healthy homeostasis. A healthy balance!

Neutrophil (source Wikipedia)

The neutrophils promote colonisation resistance, a low-level protective inflammatory response that helps the mouth fend off an excess of unhealthy bacteria and resist infection. At the same time, the neutrophils help ensure the proper microbial composition for normal periodontal bone and tissue function.

The research recognises the importance of regular cleaning and flossing, which prevent too much plaque build-up. Unhealthy balance!

Excessive plaque and staining removed after a scale and clean

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