Gingivitis Causes and How to Treat It

Gingivitis is a reversible form of gum disease caused by the buildup of plaque on the tooth’s surface. It causes non-destructive inflammation of the gums but, if left untreated, can progress to a more serious form of the disease called periodontitis. Regular oral hygiene, including periodic visits to the dentist, is the best means of prevention.

Studies suggest that between 20% and 50% of people worldwide have gum disease. It is important to recognize the signs and symptoms of gingivitis and to seek treatment to protect your teeth and overall health.

The article details the symptoms, causes, diagnosis, and treatment of gingivitis and what you can do to avoid this all-too-common form of gum disease.

Symptoms

Gingivitis is characterized by gum inflammation. The early warning signs are often dismissed as a “natural” part of aging, with some people only taking action when serious symptoms develop.

According to the American Dental Association, common symptoms of gingivitis include:

• Red, swollen gums
• Possible gum tenderness and gum pain
• Bleeding after brushing and flossing
• A sticky film on your teeth (plaque) 
• A crusty deposit on your teeth (tartar)
• Bad breath

If left untreated, gingivitis can progress to periodontitis, an advanced form of gum disease that can cause the irreversible destruction of bone and the recession (pulling back) of the gums.

Causes

Gingivitis is most commonly caused by bacterial plaque. The persistent presence of bacteria around the teeth triggers an inflammatory response by the immune system, causing the gums to swell and turn red.

Risk factors for gingivitis include:

• Diabetes
• Smoking
• Poor oral hygiene
• Stress
• Crooked teeth
• Defective fillings
• Dental bridges that don’t fit properly
• Taking medications that cause dry mouth (including blood thinners, calcium channel blockers, and phenytoin)
  
• Changes in female hormones, such as caused by pregnancy or birth control
• Vitamin A and C deficiencies
  
• Underlying immunodeficiency, such as HIV
  

Diagnosis

Gingivitis is diagnosed with a comprehensive dental exam. This not only involves dental X-rays and an inspection of your teeth and gums but also a review of your medical and dental history. The exam may be performed by a dentist or a dental hygienist, but the interpretation of the results are ultimately done by a dentist.

During the exam, each tooth is inspected, and a score of 0 to 3 is given for each of four tooth surfaces: distal (back-side), buccal (cheek-side), lingual (tongue-side), and mesial (front-side). The scores are then averaged to give each tooth a single score.

The scores are based on the gingival index (GI) which classifies the quality of the gums, as follows:

• 0: Normal
• 1: Mild inflammation with no bleeding on inspection
• 2: Moderate inflammation with bleeding on inspection
• 3: Severe inflammation with spontaneous bleeding and ulcers

After a treatment plan is decided upon, regular follow-up visits should be scheduled to see if your condition has improved, is stable, or has progressed (worsened).

Treatment

The primary treatment of gingivitis is the removal of plaque and tartar. This is performed in the dental office with different instruments, including picks and scalers.

After the dental cleaning, you can keep plaque under control with regular brushing and flossing. Curbing or quitting tobacco use can also help.

Your dental professional may recommend chlorhexidine mouthwashes in conjunction with brushing and flossing. The stronger mouthwash may increase the risk of mouth irritation and tooth staining.

If the drugs you take contribute to your gingivitis, you may need to speak with your primary care doctor about medication adjustments. Additionally, they may prescribe a supplement if you have a vitamin deficiency.

Certain herbal remedies can also reduce gum inflammation caused by gingivitis, including tea, chamomile, and pomegranate.

Complications

Advanced untreated gum disease can lead to tooth pain or sensitivity, loose teeth, changes in your bite, tooth loss, and local infections that can become systemic (affecting other tissues or organs).

Periodontal disease also is associated with other health conditions, including cardiovascular (heart) disease. Research continues into the connections between gum disease and cancer, osteoporosis, Alzheimer's disease, and more.

A specific type of gingivitis occurs in people diagnosed with human immunodeficiency virus (HIV) infection.

Prevention

You can take steps to prevent gum disease. Good oral hygiene practices include:

• Regular tooth brushing with proper technique
• Routine use of dental floss
• Mouth rinses, such as a salt water rinse
• A healthy diet
• Avoiding tobacco

Managing other illnesses well (like taking your diabetes medication) can limit the risks associated with gum disease. Your dental care professional can advise you on the best strategies for oral health.

When to See a Dentist

Most people need to see a dentist twice a year for routine cleaning and an exam. A survey conducted by the Agency for Healthcare Research and Quality found that only 46% of respondents went to the dentist at least once a year, which increases their risk for gingivitis.

Your visit also may include X-rays and an oral cancer screening. But if you are experiencing symptoms commonly seen with gingivitis (like bleeding gums and bad breath), schedule an appointment as soon as possible.

Prognosis

Unlike periodontitis, the symptoms of gingivitis are fully reversible. If identified and treated properly, the affected tissues can return to normal once the plaque is removed. Routine dental care by a dentist is considered essential.

Summary

Gingivitis is a reversible form of gum disease caused by the buildup of plaque on teeth. It causes redness and swelling of the gums along with bleeding after brushing or flossing. If left untreated, gingivitis can lead to an irreversible form of gum disease called periodontitis.

The main cause of gingivitis is poor oral hygiene, so careful brushing and flossing can improve symptoms. But other factors can contribute, such as crooked teeth, tobacco use, ill-fitting dental bridges, and certain medications. Your dental professional can help to diagnose and treat gingivitis.