Skin Problems with Diabetes – Part 2

Continued from the previous blog. Unfortunately, the numbers have to change.

1. Rashes, Bumps, and Blisters,
   Rashes and bumps: Allergic reactions to foods, bug bites, and medicines can cause rashes, depressions, or bumps on the skin. It is especially important for people with diabetes to check for skin problems, such as rashes or bumps, in the areas where they inject their insulin.
   Diabetic blisters (bullosis diabeticorum): In rare cases, people with diabetes develop skin problems, such as blisters that resemble burn blisters. These blisters can occur on the fingers, hands, toes, feet, legs, or forearms. Diabetic blisters usually are painless and heal on their own. These skin problems often occur in people who have severe diabetes and diabetic neuropathy. Bringing your blood sugar level under control is the medical treatment for this health condition.
   Disseminated granuloma annulare: This skin condition causes sharply defined, ring or arc-shaped areas on the skin. These rashes most often occur on the fingers and ears, but they can occur on the chest and abdomen. The rash can be red, red-brown, or skin colored. Medical treatment usually is not required, but sometimes a topical steroid medication, such as hydrocortisone, may help.
   
   
2. Diabetes and Bacterial, Fungus Infections, and
   Bacterial infections: There are different kinds of bacterial infections commonly affecting the skin of those with diabetes. Skin infections with the bacteria known as Staphylococcus are more common and more serious in people with diabetes which is not under control. These bacteria can result in 'boils', an inflamed nodule from a hair follicle, which can occur in areas where hair follicles can be irritated. Other infections include styes, which are infections of the glands of the eyelids, and bacterial nail infections. Most bacterial infections require medical treatment with antibiotics in the form of pills and/or creams.
   Fungal infections: A yeast-like fungus called "Candida albicans" is responsible for many of the fungal infections causing skin problems in people with diabetes. Women in particular are prone to infection with this fungus in the vagina. Other commonly seen areas of infection include the corners of the mouth with what is known as "angular cheilitis," which feels like small cuts on the corners of the mouth. Fungus also can occur in between the toes and fingers and in the nails (onychomycosis). This fungus creates itchy, bright red rashes, often surrounded by tiny blisters and scales. These infections most often occur in warm, moist folds of the skin. Three common fungal infections are: jock itch (red, itchy area on the genitals and the inside of the thighs), athlete's foot (affects the skin between the toes), and ringworm (ring-shaped, scaly patches that can itch or blister and appear on the feet, groin, chest and abdomen, scalp, or nails). Medicines that kill the fungus are usually needed to treat these infections. A rare but potentially fatal fungal infection with Mucormycosis is seen in people with diabetes. The infection usually starts in the nasal cavities and can spread to the eyes and brain. 
   
   
3. Skin Problems with Multiple Causes.
   Itching: Itching skin, also called pruritus, can have many causes, such as a yeast infection, dry skin, or poor blood flow. When itching is caused by poor blood flow, the lower legs and feet are most often affected. Using lotion can help to keep your skin soft and moist, and prevent itching due to dry skin. 
   
   
   Managing your diabetes is the most important factor in preventing these skin problems. Follow your doctor's advice regarding nutrition, exercise, and medication. Keep your blood sugar level within the range recommended by your doctor. Proper skin care can also help reduce your risk of skin problems with diabetes. There may be other skin problems, but there are articles of many of the above with graphic pictures included on other sites. So use the names in the article for search engine results.
   
   
   The sites for more reading are the clevelandclinic and healthline. Some images can be found at this link or you can type in the name of the skin problem and then click on 'images' above the different listings.

Skin Problems with Diabetes – Part 1

If you have diabetes, potentially serious skin problems can be part of your life also. See your doctor as soon as you notice a problem and before it gets out of control. In most cases, these skin problems can be managed with early diagnosis and treatment.

WebMD lists the following:

1. Some Skin Problems Linked to Diabetes,
   Scleroderma diabeticorum: While rare, this skin problem affects people with type 2 diabetes, causing a thickening of the skin on the back of the neck and upper back. The treatment is to bring your blood sugar level under control. Lotions and moisturizers may help soften skin.
   Vitiligo: Vitiligo, a skin problem more commonly associated with type 1 diabetes than type 2 diabetes, affects skin coloration. With vitiligo, the special cells that make pigment (the substance that controls skin color) are destroyed, resulting in patches of discolored skin. Vitiligo often affects the chest and abdomen, but may be found on the face around the mouth, nostrils, and eyes. Current treatment options for vitiligo include topical steroids and micropigmentation (tattooing). If you have vitiligo, you should use sunscreen with an SPF of 30 or higher to prevent sunburn on the discolored skin. 
   
   
2. Skin Problems Linked to Diabetes and Insulin Resistance,
   Acanthosis nigricans. This is a skin problem that results in the darkening and thickening of certain areas of the skin especially in the skin folds. The skin becomes tan or brown and is sometimes slightly raised and described as velvety. Most often the condition, which typically looks like small warts, appears on the sides or back of the neck, the armpits, under the breast, and groin. Occasionally the top of the knuckles will have a particularly unusual appearance. Acanthosis nigricans usually strikes people who are very overweight. While there is no cure for acanthosis nigricans, losing weight may improve the skin condition. Acanthosis nigricans usually precedes diabetes and is considered to be a marker for the disease. There are other health conditions that also are known to cause acanthosis of the skin and these include acromegaly and Cushing syndromes. It is thought that this health condition is a skin manifestation of insulin resistance. 
   
   
3. Skin Problems Associated With Reduced Blood Supply to the Skin.
   Skin problems linked to atherosclerosis: Atherosclerosis is a serious health condition caused by the narrowing of blood vessels from a thickening of the vessel walls due to plaque buildup. While atherosclerosis most often is associated with blood vessels in or near the heart, it can affect blood vessels throughout the body, including those that supply blood to the skin. When the blood vessels supplying the skin become narrow, changes occur to the skin due to a lack of oxygen, such as hair loss, thinning and shiny skin especially on the shins, thickened and discolored toenails, and cold skin. Because blood carries the white blood cells that help fight infection, legs and feet affected by atherosclerosis heal more slowly when they are injured.
   Necrobiosis lipoidica diabeticorum: Necrobiosis lipoidica diabeticorum (NLD) is thought to be caused by changes in the collagen and fat content underneath the skin. The overlaying skin area becomes thinned and reddened. Most lesions are found on the lower parts of the legs and can ulcerate if subjected to trauma. Lesions have fairly well defined borders between them and normal skin. Sometimes, NLD is itchy and painful. As long as the sores do not break open, treatment is not necessary. If the sores do break open, see your doctor for medical treatment.
   Diabetic dermopathy: Also called shin spots, this skin condition develops as a result of changes to the blood vessels that supply the skin. Dermopathy appears as a shiny round or oval lesion of thin skin over the front lower parts of the lower legs. The patches do not hurt, although rarely they can be itchy or cause burning. Medical treatment generally is not necessary.
   Digital sclerosis: Digital sclerosis is a health condition in which the skin on your toes, fingers, and hands become thick, waxy, and tight. Stiffness of the finger joints also may occur. The medical treatment is to bring your blood sugar level under control. Lotions and moisturizers may help soften the skin.
   Eruptive xanthomatosis: This skin condition may occur when blood sugar levels are not well controlled and when triglycerides rise to extremely high levels. Severe resistance to insulin makes it difficult for the body to clear the fat from the blood. With extreme elevations in these blood fats people are at risk for pancreatitis, an inflammation of the pancreas. Eruptive xanthomas appear as firm, yellow, waxy pea-like bumps on the skin. The bumps -- which are surrounded by red halos and are itchy -- usually are found on the face and buttocks. They also can be seen on the back side of the arms and legs as well as in the creases of the extremities. Treatment for eruptive xanthomatosis consists of controlling the level of fats in your blood. The skin eruptions will resolve over a few weeks. Drugs that control different types of fats in the blood (lipid-lowering drugs) may also be needed.

Infections – Part 2

People with diabetes need to be more aware of infections, their causes, and the problems infections can cause. Everyone can have infections, but people with unmanaged diabetes are more susceptible to infections because of higher blood glucose levels. The higher blood glucose levels can furnish the bacteria, fungus, and E coli food to thrive.

People with diabetes are more susceptible to developing infections, as high blood glucose levels can weaken the patient's immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body's vulnerability to infection.

People with diabetes are especially prone to foot infections, yeast infections, urinary tract infections and surgical site infections. A diabetic's insulin injection sight can be a possible infection source. Injections provide a potential gateway for certain immune-suppressing agents to enter the blood. For example, common bacteria such as Staphylococcus aureus can enter the blood system and cause what is known as a staph infection.

A lot of people have no problems with insulin injections and some recommend using alcohol wipes over the area in which insulin is to be injected.

In addition, yeast cells (Candida albicans) that occur naturally in the mucous membranes (e.g., mouth, vagina, nose) can enter the blood system at the injection sight. These Candida cells then interfere with the normal infection-fighting action of white blood cells. With white blood cells impaired, Candida can replicate unchecked, causing yeast infections. High blood glucose levels contribute to this process.

Diabetic neuropathy (nerve damage) causes problems with sensation, particularly in the feet. This lack of sensation sometimes means foot injuries go unnoticed. Untreated injuries can lead to infection. Some types of neuropathy can also lead to dry, cracked skin, which allows a convenient entry point for infection into the body. People with diabetes often have low blood flow to the extremities. With less blood flow, the body is less able to mobilize normal immune defenses and nutrients that promote the body's ability to fight infection and promote healing.

People with diabetes are more adversely affected when they get an infection than someone without diabetes, because diabetics have weakened immune defenses. Studies have shown that diabetics (even those who have minimally elevated blood sugar levels) experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalization and recovery times. I have been fortunate in the few times that I have been in the hospital that I have healed with no problems.

Good urinary hygiene, especially for women, can help minimize the possibility of developing urinary tract infections. This includes proper toilet hygiene, prompt urination after sexual intercourse, regular emptying of the bladder and ample fluid intake.

Some examples of body changes that diabetics should be alerted to can include a rise in body temperature or change in blood glucose levels; pain with urination, or cloudy, bloody or foul-smelling urine; difficulty or painful swallowing; changes in bowel habits; and warmth or redness at any cut or scrape, including minor trauma locations and surgical sites. Any of these symptoms should be noted and mentioned to the patient's healthcare team.

Care should be taken visually to inspect your feet and lower legs on a daily basis (using a mirror if necessary). This is important if you have neuropathy.

Infections – Part 1

Infections can happen at any time, but are more common when diabetes is not well managed. Below are some of the types of infection with a brief discussion of each.

Streptococcus is a type of bacteria. There are two types: group A and group B.

Group A strep causes

• Strep throat - a sore, red throat, sometimes with white spots on the tonsils
• Scarlet fever - an illness that follows strep throat. It causes a red rash on the body.
• Impetigo - a skin infection
• Toxic shock syndrome
• Cellulitis and necrotizing fasciitis (flesh-eating disease)

Group B strep can cause blood infections, pneumonia, and meningitis in newborns. A screening test during pregnancy can tell if you have it. If you do, IV antibiotics during labor can save your baby's life. Adults can also get group B strep infections, especially if they are elderly or already have health problems. Strep B can cause urinary tract infections, blood infections, skin infections, and pneumonia in adults.

Antibiotics are used to treat strep infections.

E. coli is the name of a type of bacteria that lives in your intestines. Most types of E. coli are harmless. However, some types can make you sick and cause diarrhea. One type causes travelers' diarrhea. The worst type of E. coli causes bloody diarrhea, and can sometimes cause kidney failure and even death. These problems are most likely to occur in children and in adults with weak immune systems.

You can get E. coli infections by eating foods containing the bacteria. Symptoms of infection include

• Nausea or vomiting
• Severe abdominal cramps
• Watery or very bloody diarrhea
• Fatigue
• Fever

To help avoid food poisoning and prevent infection, handle food safely. Cook meat well, wash fruits and vegetables before eating or cooking them, and avoid unpasteurized milk and juices. You can also get the infection by swallowing water in a swimming pool contaminated with human waste.

Most cases of E. coli infection get better without treatment in 5 to 10 days.

Staphylococcus is a type of bacteria. There are over 30 types, but Staphylococcus aureus causes most staph infections (pronounced "staff infections"), including

• Skin infections
• Pneumonia
• Food poisoning
• Toxic shock syndrome
• Blood poisoning (bacteremia)

Skin infections are the most common. They can look like pimples or boils. They may be red, swollen, and painful, and sometimes have pus or other drainage. They can turn into impetigo, which turns into a crust on the skin, or cellulitis, a swollen, red area of skin that feels hot.

Anyone can get a staph skin infection. You are more likely to get one if you have a cut or scratch, or have contact with a person or surface that has staph bacteria. The best way to prevent staph is to keep hands and wounds clean. Most staph skin infections are easily treated with antibiotics or by draining the infection. Some staph bacteria such as MRSA (methicillin-resistant Staphylococcus aureus) are resistant to certain antibiotics, making infections harder to treat.

Next, we must visit the fungal infections. Yeast is a fungus that normally lives in the vagina in small numbers. A vaginal yeast infection means that too many yeast cells are growing in the vagina. These infections are very common. Although they can bother you a lot, they are not usually serious. And treatment is simple.

Most yeast infections are caused by a type of yeast called Candida albicans. A healthy vagina has many bacteria and a small number of yeast cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms, like the yeast, under control.

When something happens to change the balance of these organisms, yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes this imbalance. The high estrogen levels caused by pregnancy or hormone therapy can also cause it. So can certain health problems, like diabetes.

Skin infections can involve bacteria, fungus and yeast infections. Several kinds of bacterial infections occur in people with diabetes:

• Styes (infections of the glands of the eyelid)
• Boils
• Folliculitis (infections of the hair follicles)
• Carbuncles (deep infections of the skin and the tissue underneath)
• Infections around the nails

Inflamed tissues are usually hot, swollen, red, and painful. Several different organisms can cause infections, the most common being Staphylococcus bacteria, also called staph.

Once, bacterial infections were life threatening, especially for people with diabetes. Today, death is rare, thanks to antibiotics and better methods of blood glucose management.

But even today, people with diabetes have more bacterial infections than other people do. Doctors believe people with diabetes can reduce their chances of these infections by practicing good skin care. If you think you have a bacterial infection, see your doctor.

The culprit in fungal infections of people with diabetes is often Candida albicans. This yeast-like fungus can create itchy rashes of moist, red areas surrounded by tiny blisters and scales. These infections often occur in warm, moist folds of the skin. Problem areas are under the breasts, around the nails, between fingers and toes, in the corners of the mouth, under the foreskin (in uncircumcised men), and in the armpits and groin.

Common fungal infections include jock itch, athlete's foot, ringworm (a ring-shaped itchy patch), and vaginal infection that causes itching. If you think you have a yeast or fungal infection, call your doctor.

Localized itching is often caused by diabetes. It can be caused by a yeast infection, dry skin, or poor circulation. When poor circulation is the cause of itching, the itchiest areas may be the lower parts of the legs.

You may be able to treat itching yourself. Limit how often you bathe, particularly when the humidity is low. Use mild soap with moisturizer and apply skin cream after bathing.

Periodontal Disease – Part 3

Follow your dentist's recommended schedule for regular checkups. If you notice any symptoms of periodontitis, make an appointment with your dentist as soon as possible.

Here's some information to help you get ready for your appointment and know what to expect from your dentist. Your dentist may ask you questions about your symptoms, such as:

• When did you first start experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How often do you brush your teeth?
• Do you use dental floss? How often?
• Do you see a dentist regularly?
• What medical conditions do you have?
• What medications do you take?
• Do you use tobacco products?

Depending on the extent of your periodontitis, your dentist may refer you to a specialist in the treatment of periodontal disease (periodontist).

Diagnosis of periodontitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth. Your dentist will look for plaque and tartar buildup and check for easy bleeding. To determine how severe your periodontitis is, your dentist may:

• Use a dental instrument to measure the pocket depth of the groove between your gums and your teeth. Your dentist or a dental hygienist inserts a metal probe beside your tooth beneath your gum line, usually at several sites throughout your mouth. In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters (mm). Pockets deeper than 5 mm may indicate periodontitis.
• Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.

If periodontitis isn't advanced, treatment may involve less invasive procedures, including:

• Scaling. Scaling removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device.
• Root planing. Root planing smoothes the root surfaces, discouraging further buildup of tartar and bacterial endotoxin.
• Antibiotics. Your periodontist or dentist may recommend using topical or oral antibiotics to help control bacterial infection. Topical antibiotics can include antibiotic mouth rinses or insertion of gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. However, oral antibiotics may be necessary completely to eliminate infection-causing bacteria.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, periodontitis treatment may require dental surgery, such as:

• Flap surgery (pocket reduction surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and root planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. After you heal, it's easier to clean these areas and maintain healthy gum tissue.
• Soft tissue grafts. When you lose gum tissue to periodontal disease, your gum line recedes. You may need to have some of the damaged soft tissue reinforced. This is usually done by removing a small amount of tissue from the roof of your mouth (palate) or another donor source and attaching it to the affected site. This procedure can help reduce further gum recession, cover exposed roots, and give your teeth a more pleasing appearance.
• Bone grafting. This procedure is performed when periodontitis has destroyed the bone surrounding your tooth root. The graft may be composed of small fragments of your own bone, or the bone may be synthetic or donated. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.
• Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.
• Enamel matrix derivative application. Another technique involves applying a special gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue.

Try these measures to reduce or prevent periodontitis:

• Get regular professional dental cleanings, on a schedule recommended by your dentist.
• Use a soft toothbrush and replace it at least every three to four months.
• Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
• Brush your teeth twice a day or, better yet, after every meal or snack.
• Floss daily.
• Use a mouth rinse to help reduce plaque between your teeth.
• Supplement brushing and flossing with an interdental cleaner, such as a dental pick, interdental brush or dental stick specially designed to clean between your teeth.

Care of your teeth is important!

Periodontal Disease – Part 2

Periodontitis is the last topic in periodontal disease. Periodontitis is a serious gum infection (I will not cover this under infections) that damages the soft tissue and destroys the bone that supports your teeth. Periodontitis can cause tooth loss or worse, an increased risk of heart attack or stroke and other serious health problems.

Periodontitis is usually the result of poor oral hygiene. Brushing at least twice a day, flossing daily, and getting regular dental checkups can greatly reduce your chance of developing periodontitis. It is also preventable by using the above oral hygiene.

Signs and symptoms of periodontitis can include:

• Swollen gums
• Bright red or purplish gums
• Gums that feel tender when touched
• Gums that pull away from your teeth (recede), making your teeth look longer than normal
• New spaces developing between your teeth
• Pus between your teeth and gums
• Bad breath
• Bad taste in your mouth
• Loose teeth
• A change in the way your teeth fit together when you bite

There are different types, or classes, of periodontitis. Chronic periodontitis is the most common class, affecting mostly adults, though children can be affected, too. Aggressive periodontitis usually begins in childhood or early adulthood and affects only a small number of people.

Factors that can increase your risk of periodontitis include:

• Gingivitis
• Heredity
• Poor oral health habits
• Tobacco use
• Diabetes
• Older age
• Decreased immunity, such as that occurring with leukemia, HIV/AIDS or chemotherapy
• Poor nutrition
• Certain medications
• Hormonal changes, such as those related to pregnancy or menopause
• Substance abuse
• Poor-fitting dental restorations
• Problems with the way your teeth fit together when biting

Some complications associated with gum disease include:

• Tooth loss
• Coronary artery disease
• Stroke
• Premature, low birth weight babies
• Poorly controlled diabetes
• Respiratory problems
• Rheumatoid arthritis
• Asthma

If your gums are puffy, dusky red and bleed easily, or show other signs or symptoms of periodontitis, see your dentist soon. The sooner you seek care, the better your chances of reversing damage from periodontitis, potentially preventing other serious health problems.

It is believed that periodontitis begins with plaque, a sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth removes plaque. Plaque re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gum line into tartar (calculus). Tartar also may form because of the mineral content of your saliva. Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. You can't get rid of tartar by brushing and flossing, you need a professional dental cleaning to remove it.

The longer you allow plaque and tartar to remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is called gingivitis, the mildest form of periodontal disease.

The continuing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar, and bacteria. Bacteria deposit endotoxin, a byproduct of their own metabolism, which is responsible for much of the inflammation around teeth. In time, these pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.

Some research suggests that the bacteria responsible for periodontitis can enter your bloodstream through your gum tissue, affecting your lungs, heart, and other organs of your body. For instance, bacteria may travel to the arteries in your heart, where they might trigger a cycle of inflammation and arterial narrowing that contributes to heart attacks.

Periodontal Disease – Part 1

Everyone tells you to see your eye doctor once a year to check for eye problems and have a dilated eye exam, but few even talk about seeing your dentist on a yearly basis or more often. I don't understand why this happens. It would seem that this should also be a requirement for people new to diabetes. This will establish a baseline for your dentist to use when he does checkups in the future.

Unfortunately, like eye diseases and other diabetes complications, there are three problems associated with oral health:

1. Gingivitis
2. Trench mouth
3. Periodontitis

I will start with trench mouth, as in most developed countries, it is a rarity today. Trench mouth was named for the condition among soldiers during World War I who were in trenches without the means to take care of their teeth. Trench mouth is not contagious.

Trench mouth is a severe form of gingivitis that causes painful, infected, bleeding gums, and ulcerations.

Now I will turn to gingivitis. When it comes to periodontal disease, gingivitis is the common and mild form of gum disease. And because gingivitis can be mild, you may not be aware you have it. This is the reason to see the dentist annually, if not more often. Gingivitis can lead to much more serious gum disease (periodontitis) and eventual tooth loss.

Signs and symptoms of gingivitis include:

1. Swollen gums
2. Soft, puffy gums 
3. Receding gums
4. Occasionally, tender gums 
5. Gums that bleed easily when you brush or floss, sometimes seen as redness or pinkness on your brush or floss
6. A change in the color of your gums from a healthy pink to dusky red 
7. Bad breath

The most common cause of gingivitis is poor oral hygiene that encourages plaque to form. Plaque is an invisible, sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth at least twice a day and flossing each day removes plaque. Plaque requires daily removal because it re-forms quickly, usually within 24 hours. This means for people with diabetes that this is most important, especially when diabetes is poorly managed/

Factors that can increase your risk of gingivitis include:

• Poor oral health habits
• Tobacco use
• Diabetes
• Older age
• Decreased immunity as a result of leukemia, HIV/AIDS or other conditions
• Certain medications
• Certain viral and fungal infections
• Dry mouth
• Hormonal changes, such as those related to pregnancy, your menstrual cycle or use of birth control pills
• Poor nutrition
• Substance abuse
• Ill-fitting dental restorations

Steps you can take at home to prevent and reverse gingivitis include:

• Get regular professional dental cleanings, on a schedule recommended by your dentist.
• Use a soft toothbrush and replace it at least every three to four months.
• Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
• Brush your teeth twice a day, or better yet, after every meal or snack.
• Floss at least once a day.
• Use an antiseptic mouthwash, if recommended by your dentist.
• Use an interdental cleaner, such as a dental pick or dental stick specially designed to clean between your teeth.

If you're consistent with your home hygiene, you should see the return of pink, healthy gum tissue within days or weeks. You'll need to practice good oral hygiene for life, so your gum problems don't return.