What Is Gingivitis?

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 way to avoid this all-too-common condition.

Studies suggest that more than half of adults in the United States have gingivitis. Because of this, it is important to recognize the signs and symptoms of gingivitis and to seek treatment to protect your teeth and overall health.

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
• 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:

• Inadequate oral hygiene
• Crooked or overlapping teeth
• Defective fillings
• Dental bridges that don't fit properly
• Taking medications that cause dry mouth (including blood thinners, calcium channel blockers, phenytoin, and vitamin A)
  
• Changes in female hormones, such as caused by pregnancy or hormonal birth control
• Long-term stress, which can weaken the immune system
• Smoking or tobacco chewing
• Vitamin C deficiency
  
• Underlying immunodeficiency, such as HIV
• Diabetes
  

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. Powered oscillating toothbrushes usually work better at controlling plaque than manual toothbrushes.

Chlorhexidine mouthwashes may also be recommended in conjunction with brushing and flossing. (Despite what some people might tell you, "stronger" chlorhexidine mouthwashes work no better than less concentrated formulations and may only increase the risk of mouth irritation and tooth staining).

Other interventions may be recommended. If the drugs you take are contributing to your gingivitis, you may be advised to speak with your primary care doctor about medication adjustments. If you have vitamin C deficiency, a supplement may be prescribed. Curbing or quitting tobacco use can also help.

Certain herbal remedies have also been shown to reduce gum inflammation caused by gingivitis, including tea, chamomile, and pomegranate.

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.

A Word From Verywell

As much as you can control gingivitis with regular brushing and flossing, you shouldn't assume that doing so makes dental visits any less important. Gingivitis can sometimes occur even if you regularly brush and floss and, if left untreated, can lead to permanent gum or tooth damage.

Today, only around 58% of people in the United States see a dentist regularly. This largely accounts for why gingivitis and other oral diseases are so common. By seeing a dentist twice yearly, you can avoid complications that may not only be more difficult to treat but more costly to treat.