What is Gingivitis? (Causes, Symptoms & Treatment)

Have you recently visited the dentist for a basic cleaning only to hear you have gingivitis? You’re not alone; 94% of Americans have gingivitis.

If gingivitis is left untreated, it can progress into gum disease, also known as periodontal disease.

Periodontal disease consists of irreversible bone loss that can lead to loose teeth. Understanding gingivitis causes, symptoms and treatment options will help eliminate harmful bacteria for improved oral health.

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What Is Gingivitis?

Gingivitis is inflammation of the gums caused by harmful bacteria. If your dentist or hygienist does not remove harmful bacteria, the bacteria will congregate and multiply into advanced gum disease (periodontal disease).

The bacteria that infects the gums lead to swollen, red and puffy gums. Gingivitis is a common gum issue; however, oral hygiene improvements can help prevent this ailment. According to the American Dental Association, gingivitis and periodontitis cause tooth loss in adults.

Common Causes

1. Poor oral hygiene – If regular brushing and flossing habits are not maintained, dental plaque will form on teeth, causing gum inflammation. However, improved oral hygiene and regular visits to the dentist for routine cleanings aid in the removal of dental plaque. A more severe gum disease (periodontal disease) will occur if left untreated.
2. Poor nutrition – Harmful bacteria rely on sugars and carbohydrates to multiply. The bacteria begin to proliferate (increase in number) after it congregates – brushing, flossing and routine cleanings prevent harmful bacteria from forming above and below the gum tissue. Foods high in sugars and carbohydrates are sticky and desirable for oral bacteria.
3. Dental plaque – Occurs when food debris is not removed, most commonly along the tooth and gum margin. It may feel a bit “fuzzy” when you run your tongue over it. Dental plaque is composed of bacteria that “eat” sugars. Acid formation and other byproducts form, leading to gum inflammation. To limit dental plaque, brush twice daily and floss nightly.
4. Tartar – Plaque that stays on your teeth can harden under your gumline into tartar (calculus), which invites more bacteria formation. Tartar protects plaque from breaking down, creating a protective shield for bacteria. In addition, tartar formation causes gum irritation and inflammation. Unlike plaque, tartar cannot be removed at home and requires a dental cleaning to remove it.

Signs & Symptoms

It’s possible to have gingivitis without any symptoms. However, in mild cases of gingivitis, there may be no discomfort or noticeable symptoms. Often, it remains undetected for quite some time. The symptoms of gingivitis are somewhat non-specific.

Additionally, the pink-salmon coloring and stippling in the gum tissue will often disappear. Also, the gums may appear shiny as the gum tissue becomes inflamed and stretched over the tissue surface.

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When the gums are swollen, the lining becomes ulcerated, and the gums are prone to bleed even with gentle brushing and flossing. In addition, if the gums are inflamed, they may start pulling away from the neck of the tooth. This causes gaps between the teeth and the gums, known as gum pockets (or periodontal pockets).

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Similarly, many people aren’t aware that they have gum disease (periodontal disease). Periodontal disease, also known as periodontitis, can cause teeth to shift position, wobble or hurt when you chew. In addition, periodontal disease will lead to irreversible bone loss.

Periodontal disease is treated with scaling and root planing, also known as deep cleaning. If gum disease is not controlled, your dentist will refer you to a gum specialist known as a periodontist.

Common Risk Factors

Specific risk factors increase the likelihood of developing gingivitis and periodontitis. Certain medications, such as antiseizure and immunosuppressants, can lead to gingival hyperplasia (gum overgrowth).

Other Risk Factors

Diagnosis

Your dental exam consists of an intraoral and extraoral exam along with complete series of dental x-rays. X-rays allow the dentist to check for cavities and bone loss. In addition, the clinician will probe your gums with a dental instrument to check gum inflammation. The small millimeter measuring tool measures pockets around your teeth.

Typical gum measurement depths are 1 to 3 millimeters.

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A dentist or hygienist will check for gingivitis signs, including gum inflammation, plaque and tartar around your teeth. Gingivitis is a precursor to periodontal disease.

Periodontal disease is different than gingivitis in that there is gum inflammation + bone loss.

In addition, gingivitis is reversible, unlike periodontal disease, which is irreversible. Gum disease can be managed but is classified as either active or inactive. Periodontal maintenance cleanings work to maintain gum disease in an idle state.

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Common Complications

Following the clinicians instructions will typically prevent further complications. Chronic gingivitis is associated with systemic diseases such as respiratory disease, diabetes, coronary artery disease, stroke and rheumatoid arthritis.

In addition, research suggests that the bacteria responsible for periodontitis can enter your bloodstream through the gum tissue, possibly affecting your heart, lungs and other body parts.

Other complications include:

1. Periodontal disease – Untreated gingivitis can progress to gum disease that spreads to underlying tissue and bone. Periodontal disease, gum disease and periodontitis all mean the same thing and are much more severe conditions that can lead to tooth loss.
2. Trench mouth – Acute necrotizing ulcerative gingivitis (ANUG/NUG), also known as “trench mouth,” is a severe form of gum disease that causes painful, infected, bleeding gums and ulcerations. Trench mouth is rare in developed nations, though it’s common in developing countries with poor nutrition and living conditions.
3. Periodontal/tooth abscess – Harmful bacteria that cause gingivitis and periodontal disease can progress along the tooth root and lead to a tooth abscess. If the infection is localized within the gums, it’s called a periodontal abscess. However, if the abscess forms along the tooth root, it’s known as a tooth abscess.
4. Recurrent gingivitis – This occurs if harmful bacteria are removed above the gums while leaving bacteria below the gums. For example, regular cleaning (prophylaxis) cleans the teeth above the gums. This will temporarily heal the gums; however, it traps harmful bacteria below the gums leading to a recurrence of gingivitis.

Treatment (Evidence-Based Research)

The clinician will educate you about the disease if you are diagnosed with gingivitis or periodontitis.

In addition, they will review how to properly care for your mouth. Treatment for gingivitis includes cleaning the gums and teeth above and below the gum line. Dental scaling instruments are used to remove plaque and tartar. In addition, an ultrasonic scaler rapidly vibrates to remove tenacious tartar.

I recommend having your dentist smooth any ledges or rough edges of fillings and crowns. These issues will snag floss and harbor harmful bacteria that can lead to gum disease and tooth decay.

Other treatment recommendations include:

In-Office Treatment

1. Chlorhexidine – According to a recent study, chlorhexidine mouth rinse reduces gingivitis. Chlorhexidine can be used in-office and at home (prescription only). However, Chlorhexidine can cause tooth staining if used for an extended period.
2. Laser therapy – According to research, low-level laser therapy reduces gingival inflammation. Laser therapy + Chlorhexidine was more effective at removing gum inflammation. Laser therapy is commonly used to treat periodontal disease.
3. Fluoride treatment – According to a recent study, stannous fluoride (0.45%) effectively reduced gingival bleeding. However, a more significant reduction is observed if stannous fluoride is used with prophylaxis cleaning.
4. Arestin – Arestin (Minocycline HCl) microspheres, in conjunction with scaling and root planing (periodontal treatment), reduces overall pocket depths. This antibiotic is delivered below the gum line to kill the bacteria at the source.

At-Home Treatment

1. Electric toothbrush – Powered toothbrushes are more effective at removing plaque and harmful bacteria than manual toothbrushes. In addition, electric toothbrushes are loaded with features, including timers, brushing detection, subscription brush heads, and oscillating technology.
2. Flossing – Flossing is effective at removing bacteria between the teeth. Use a “C-shaped” flossing method to wrap around each tooth. Water flossing is more effective at removing plaque if you have significant gaps between your teeth.
3. Water flossing – According to a study, the bacteria that causes gingivitis can be controlled by using a water flosser with a mouthwash containing an antibiotic.
4. Hydrogen peroxide – According to research, hydrogen peroxide controls gingivitis in short-term use. In addition, fluoridated hydrogen peroxide-based mouth rinse can remove teeth stains and reduce gingivitis.
5. Antibacterial mouthwash – According to a recent study, brushing alone only reaches 25% of your mouth. Bacteria and plaque were killed within 30 seconds after rinsing with Listerine’s antibacterial mouthwash (research). Mouthwashes with essential oils may be helpful, as they contain ingredients with anti-inflammatory properties, such as thymol, menthol and eucalyptol.

Best Prevention

Gingivitis is a highly prevalent gum issue; however, you can prevent it.

If your family has gum disease, you may face a greater risk of developing it. In addition, you may need more frequent checkups and cleanings to prevent gum disease.

 Recommended Reading: Is Gingivitis & Gum Disease Contagious? (What the Research Says)

Encourage your family members to have their teeth cleaned to avoid spreading harmful bacteria between members. Talk to your dentist and dental hygienist about specific recommendations.

Best Prevention Methods

• Use electric toothbrush
• Brush twice daily
• Floss regularly
• Use mouthwash
• Regular dental visits
• Don’t smoke or use tobacco
• Control diabetes (other medical issues)
• Eat balanced diet

Gingivitis vs. Healthy Gums

 Recommended Reading: Gingivitis vs Healthy Gums (What’s the Difference?)

Gingivitis vs. Gum Disease (Periodontal Disease)

 Recommended Reading: Gingivitis vs Periodontitis (Gum Disease) Overview

Frequently Asked Questions (FAQ)

My Experience & Expertise

The prevalence of gingivitis is exceptionally high. If you’ve been diagnosed with gingivitis, don’t panic. Treat gingivitis by using an electric toothbrush twice daily, flossing nightly, visiting your dentist regularly and maintaining excellent oral hygiene.

If you don’t have gingivitis, well done. Review the prevention section to maintain health.

Knowledge is power when cultivating healthy dental habits. The more informed you are, the better positioned you’ll be to prevent avoidable and potentially costly dental procedures for you and your family. Watch for future blog posts, where we’ll continue sharing important information, product reviews and practical advice!

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Sources

• Li Y. Prevalence and severity of gingivitis in American adults. Am J Dentistry. 2010.
• Gingivitis and periodontitis: Overview Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). 2020.
• Hasturk H. Efficacy of a fluoridated hydrogen peroxide-based mouthrinse for the treatment of gingivitis: a randomized clinical trial. J. Periodontol, 2004
• WebMD. Treatments for Gum Disease 2021.
• James P. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health Cochrane Database, 2017
• Pejcic A. The effects of low level laser irradiation on gingival inflammation Photomed Laser Surg, 2010
• Parkinson CR. Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial BMC Oral Health, 2020.
• AAPD Treatment of Plaque-Induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions Journal of Periodontology, 2004.
• Stoeken J. The Long-Term Effect of a Mouthrinse Containing Essential Oils on Dental Plaque and Gingivitis: A Systematic Review Journal of Periodontology, 2007.