Gingivitis is a type of periodontal disease, which is inflammation and infection that destroys the supporting tissues of the teeth. This can include the gums, periodontal ligaments, and alveolar bone (tooth sockets).
Causes
Gingivitis is caused by the long-term effects of plaque deposits on the teeth. Plaque is a sticky material made up of bacteria, mucus, and food residue that accumulates on the exposed parts of the teeth. It is also a major cause of tooth decay. If plaque is not removed, it hardens into a deposit called tartar (or calculus) that gets trapped at the base of the tooth.
Plaque and tartar irritate and inflame the gums. Bacteria and toxins they produce cause the gums to become infected, inflamed, and sensitive.
The following factors increase the risk of gingivitis:
Certain systemic infections and diseases
Poor dental hygiene
Pregnancy (hormonal changes increase gum sensitivity)
Uncontrolled diabetes
Misaligned teeth, rough edges of fillings, and poorly fitting or contaminated oral appliances (such as dental braces, dentures, bridges, and crowns)
The use of certain medications such as phenytoin, bismuth, and some birth control pills.
Many people have some degree of gingivitis. It usually appears during puberty or early stages of adulthood, due to hormonal changes. It can persist or recur frequently, depending on the health of your teeth and gums.
Symptoms
Bleeding gums (blood on toothbrush even with gentle brushing). Bright red or purplish-red appearance of the gums, gums that are sensitive to touch but otherwise painless, mouth sores, inflamed gums, shiny-looking gums.
Tests and exams
The dentist will examine the mouth and teeth and look for soft, inflamed, or purplish-red gums. Gums are usually painless or slightly sensitive. Plaque and tartar may be observed at the base of the teeth. The dentist will use an explorer to carefully examine the gums to determine whether you have gingivitis or periodontitis. Most of the time, no further testing is needed, but dental x-rays may be taken to see if the inflammation has spread to the supporting structures of the teeth.
Treatment
The goal is to reduce inflammation. The dentist or oral hygienist will clean your teeth. They may use various instruments to loosen and remove deposits from the teeth.
Careful oral hygiene is necessary after a professional dental cleaning. The dentist or oral hygienist will show you how to brush and floss. The dentist may recommend:
Having regular dental cleanings, in addition to brushing and flossing twice a day or more often for severe periodontal disease.
Using antibacterial mouth rinses or other aids.
Repairing misaligned teeth.
Replacing dental and orthodontic appliances.
Similarly, treating any other related diseases or conditions.
Outlook (prognosis)
Some people feel discomfort when plaque is removed from their teeth. Bleeding and sensitivity of the gums should decrease within a week or two after professional cleaning and good oral hygiene at home. Antibacterial or warm saltwater rinses can reduce gum swelling. Over-the-counter anti-inflammatories may also be helpful. You should maintain good oral hygiene throughout your life or periodontal disease will recur.
Possible complications
Recurring gingivitis, Periodontitis, Infection or abscess of the gums or maxillary bone, Acute necrotizing ulcerative gingivitis.
When to contact a medical professional
See the dentist if you have redness and swelling in your gums, especially if you haven't had a routine cleaning and examination in the last six months.
Prevention
Good oral hygiene is the best way to prevent gingivitis. You should brush your teeth at least twice a day and floss at least once a day. The dentist may recommend brushing and flossing after every meal and at bedtime. Ask the dentist or oral hygienist to show you how to brush and floss properly. The dentist may suggest special devices to help remove plaque deposits. These include toothpicks and special brushes, water irrigation, or other devices. You should still brush and floss regularly. Anti-tartar and anti-plaque toothpastes or mouth rinses may also be recommended. Many dentists advise getting a professional dental cleaning at least every six months. Some plaque may still be missed even with careful brushing and flossing.
References
Amsterdam JT. Oral medicine. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 70.
Kawar N, Gajendrareddy PK, Hart T. Periodontal disease for the primary care physician. Dis Mon. 2011;57(4):174-183.
Chow AW. Infections of the oral cavity, neck, and head. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 60.