Gingivitis is inflammation of the gums. A.D.A.M.

Causes, incidence, and risk factors

Gingivitis is a form of periodontal disease. Periodontal disease is inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets (alveolar bone).

Gingivitis is due to the long-term effects of plaque deposits on your teeth. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed parts of the teeth. It is a major cause of tooth decay.

If you do not remove plaque, it turns into a hard deposit called tartar (or calculus) that becomes trapped at the base of the tooth. Plaque and tartar irritate and inflame the gums. Bacteria and the toxins they produce cause the gums to become infected, swollen, and tender.

The following raise your risk for gingivitis:

• Certain infections and body-wide (systemic) diseases
• Poor dental hygiene
• Pregnancy (hormonal changes increase the sensitivity of the gums)
• Uncontrolled diabetes
• Misaligned teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (such as braces, dentures, bridges, and crowns) Use of certain medications, including phenytoin, bismuth, and some birth control pills

Many people have some amount of gingivitis. It usually develops during puberty or early adulthood due to hormonal changes. It may persist or recur frequently, depending on the health of your teeth and gums.

Symptoms

• Bleeding gums (blood on toothbrush even with gentle brushing of the teeth)
• Bright red or red-purple appearance to gums
• Gums that are tender when touched, but otherwise painless
• Mouth sores
• Swollen gums
• Shiny appearance to gums

Signs and tests

The dentist will examine your mouth and teeth and look for soft, swollen, red-purple gums.

The gums are usually painless or mildly tender.

Plaque and tartar may be seen at the base of the teeth.

The dentist will use a probe to closely examine your gums to determine if you have gingivitis or periodontis.  

No further testing is usually necessary. However, dental x-rays may be done to see if the disease has spread to the supporting structures of the teeth.

See: Periodontitis

Treatment

The goal is to reduce inflammation.

The dentist or dental hygienist will clean your teeth. The may use different tools to loosen and remove deposits from the teeth.

Careful oral hygiene is necessary after professional tooth cleaning. The dentist or hygienist will show you how to brush and floss.

Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases of gum disease.

Antibacterial mouth rinses or other aids may be also be recommended.

Repair of misaligned teeth or replacement of dental and orthodontic appliances may be recommended.

Any other related illnesses or conditions should be treated.

Expectations (prognosis)

Some people have discomfort when plaque and tartar are removed from the teeth. 

Bleeding and tenderness of the gums should lessen within 1 or 2 weeks after professional cleaning and careful oral hygiene.

Warm salt water or antibacterial rinses can reduce gum swelling. Over-the-counter anti-inflammatory medications may also be helpful.

Healthy gums look pink and firm. Strict oral hygiene must be maintained for your whole life, or gum disease will recur.

Complications

• Gingivitis returns
• Periodontitis
• Infection or abscess of the gums or the jaw bones
• Trench mouth

Calling your health care provider

Call your dentist if you have red, swollen gums, especially if you have not had a routine cleaning and examination in the last 6 months.

Prevention

Good oral hygiene is the best way to prevent gingivitis.

You should brush your teeth at least twice a day. You should floss at least once a day.

Your dentist may recommend brushing and flossing after every meal and at bedtime. Ask your dentist or dental hygienist to show you how to properly brush and floss your teeth.

Special devices may be recommended if you are prone to plaque deposits. They include special toothpicks, toothbrushes, water irrigation, or other devices. You still must brush and floss your teeth regularly.

Antiplaque or antitartar toothpastes or mouth rinses may also be recommended.

Regular professional tooth cleaning is important to remove plaque that may develop even with careful brushing and flossing. Many dentists recommend having the teeth professionally cleaned at least every 6 months.

References

1. Ferri FF. Ferri’s Clinical Advisor: Instant Diagnosis and Treatment. St. Louis, Mo: Mosby; 2005:447-448.
2. Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:898.
3. American Academy of Periodontology. Parameter on plaque-induced gingivitis. J Periodontol. 2000;71:851-852. [PubMed: 10875689]

Review Date: 2/22/2012.

Reviewed by: Paul Fotek, DMD, Florida Institute for Periodontics & Dental lmplants, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.