Gingivitis

What Is Gingivitis?

Dental Exam

Gingivitis is the inflammation of the gums, thus reflecting the meaning of its name. The root words come from “gingiv” = gingiva (gums) and “itis” = inflammation of.

Gingivitis usually occurs in areas where plaque biofilm has not been adequately removed. Poor or inadequate oral hygiene allows bacteria to congregate at the gumlines, triggering an inflammatory response in the body. The result is inflammation and antibodies targeting the area of bacterial buildup, otherwise known as the condition “gingivitis.” The early stages of gum infections are known as gingivitis, but as the infection becomes more severe it can lead to periodontal disease (gum disease), bone loss and tooth loss. It is estimated that up to 90% of adults in the U.S. suffer from some form of gingivitis. Areas with gingivitis are tender to the touch or may bleed during oral hygiene procedures.

What Does Gingivitis Look Like?

Gingivitis is the inflammation of the gums resulting in:

  • Swollen or blunted gums
  • Red or purple gums
  • Gums that are tender
  • Bleeding during brushing or flossing

Healthy gums do not bleed, thus bleeding gums is a symptom of existing gingivitis. The swelling and redness of the gums may be localized to the papilla (the sharp pointed gum area between the teeth), generalized along the entire gum margin near the neck of the tooth, or more diffuse and extended far down into the gumlines. The gums may be slightly swollen, or have the appearance of an inner tube along the margins. Coloration of the gums in gingivitis can range from a slightly pinker shade than healthy gingiva to areas that are bright red or even purple. If gingivitis progresses into severe states such as periodontal disease, the root surfaces may be exposed as well (recession).

 

Causes

What Causes Gingivitis?

Gingivitis is caused by the following factors:

  • Plaque biofilm
  • Your body’s immune system
  • Poor or inadequate oral hygiene

Gingivitis is your body’s inflammatory system’s response to bacteria in an area of the mouth where it should not be. Bacterial plaque easily congregates at the gumlines of the teeth and may extend to areas under the gums as well as between the teeth. When this bacterium is not removed adequately on a routine basis, the body begins to attack the area, sending antibodies to destroy the plaque.

It is similar to having an injury on another portion of your body – if there is an open wound that collects dirt and germs and you neglect to keep it clean, the area will become red, swollen and sore. If you avoided cleaning this area, the infection would persist and become worse, leading to other problems. The same is true when germs and bacteria are not removed efficiently from the gumlines and between the teeth. Not brushing properly, often enough, or avoiding flossing can all cause gingivitis.

Gingivitis can easily be reversed, so the condition only continues to persist when routine maintenance is less than satisfactory.

Patients with missing or crowded teeth may be at more risk to develop gingivitis or gum infections in these areas because the teeth are more difficult to keep clean. Even with very good oral hygiene, shifted or crowded teeth often still collect larger amounts of plaque biofilm.

 

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Signs And Symptoms

woman dentist with her assistant

If your gums are healthy, they appear coral in color* and protrude as sharp, narrow papilla between the teeth. Gums along the margins of the teeth are completely smooth, following a natural contour along the tooth and bone.

The following conditions are symptoms of gingivitis:

  • Gums between the teeth (papilla) becoming round, swollen or blunted
  • Inflammation around the margin of the gumlines
  • Redness – ranging from a slightly darker pink to severely red or purple gums due to the blood supply under the diseased tissue area
  • Tenderness
  • Bleeding during brushing or flossing
  • Except for people with darker skin pigmentation, who may have some spotted pigment areas on healthy gums. These areas of pigmentation usually appear brown and are completely normal.

Healthy gums do not bleed when you brush or floss around them. If your gums bleed, then you are either:

  • Not brushing and flossing often enough
  • Not brushing or flossing adequately or
  • Suffering from a systemic condition (such as anemia)

By correctly brushing and flossing on a regular basis for at least two weeks your symptoms should cease. If the symptoms continue to exist then you may have more advanced gum disease or need a professional cleaning to remove calcified areas of bacteria, which are called tartar or calculus. Once tartar exists on the teeth it cannot be brushed or flossed off. Only your hygienist or dentist can remove it and it will be necessary to have it removed before healing can begin.

 

Types Of Gingivitis

The different levels of gum disease are:

  • Gingivitis
  • Early Periodontitis
  • Moderate Periodontitis
  • Advanced Periodontitis

Gingivitis is the earliest and most simple form of gum disease. Thankfully you can also reverse and completely cure it! While it is less severe than other forms of gum disease, there are also various types of gingivitis. These include:

Acute Necrotizing Ulcerative (“Trench Mouth”) – This severe form of gingivitis is less common and occurs as severely ulcerated gums that appear to have “punched out” areas in the tissue. It usually includes a heightened immune response and involves inflammation of the lymph nodes.

Drug-induced – Medications that are taken can cause gingival “hyperplasia” or overgrowth of gum tissue. This condition is usually managed by addressing your medication needs with your primary care physician. In some cases there may be some gum modification through laser therapy by your dentist.

Hormonal – Some gingivitis is induced during pregnancy due to hormonal imbalances. Even with very good oral hygiene there may be some gum swelling and bleeding. Typically the condition will reverse itself after the baby is delivered.

Nutritional – Deficiencies such as anemia may cause pallor of the gums with heavy bleeding. If you are anemic and have bleeding during brushing or flossing, consider taking iron supplements and addressing your dietary needs. Malnutrition can contribute to various oral symptoms.

Plaque Induced – Inflammation and redness of the gums due to the presence of plaque biofilm.

Chronic – The most advanced stage of gingivitis that occurs before developing into periodontal disease.

Linear Gingival Erythema – Extremely red margins of the gumlines. There may not be bleeding present and oral hygiene may not improve the condition. It is commonly associated with HIV.

Fungal, Viral, Bacterial, Systemic Or Infectious Disease – Infectious diseases and other systemic conditions can produce symptoms of gingivitis due to the body’s response to the illness. Examples of diseases or infections that cause mucosal irritation include:

  • Herpes
  • Mononucleosis
  • Gonorrhea
  • Strep
  • Candida (fungal)
  • AIDS
  • Leukemia
  • HIV

Gingivitis can be localized or generalized, depending on the location. Localized gingivitis only affects one to a few teeth, while generalized gingivitis affects several areas or your entire mouth.

 

Dangers And Health Risks

Gingivitis doesn’t just affect the appearance or discomfort of your gums, it can also greatly affect your entire body.

Links To Other Diseases And Conditions

Gingivitis, gum disease and periodontal disease are all caused by your body’s immune response to infection in the area. When your immune system is strained by infection, it also makes it difficult to fight other conditions that you may be suffering from. The more severe your gum infection is, the more likely you are to suffer from severe health problems. (1) By treating or preventing gum infections like gingivitis, you can increase your body’s ability to recover from conditions such as (2,3):

  • Cardiovascular disease
  • Arterial plaque
  • Heart attack
  • Stroke
  • Diabetes
  • Premature labor
  • Obesity
  • Erectile dysfunction

STUDY – The Link Between Gum Disease Bacteria And Arthritis

 

 

Progression Into Periodontitis

Because the beginning stages of periodontitis (periodontal disease) evolve from gingivitis, it is extremely important to tackle your symptoms before they can cause irreversible problems. If gingivitis is allowed to persist and goes untreated, the area becomes so infected that destruction of gum attachment and bone levels occur around your teeth. This attachment loss starts out small, allowing food to pack under your gums as well as tartar to build up on the root of your teeth. Ultimately the infection becomes worse and worse until you reach the point where there is so much bone loss that your teeth become mobile and may possibly fall out.

Once you have lost teeth due to periodontal disease it makes everyday things like talking, chewing and swallowing more difficult to do. Even with tooth replacement options there is never anything quite like having your natural teeth, and you may have some problems adjusting. Bone loss from gum disease is irreversible, so it is important to prevent periodontitis by treating your gingivitis as soon as you begin to experience symptoms.

 

 

How To Prevent Gingivitis

The good news is that gingivitis is very easy to prevent! Most of the time, gingivitis symptoms occur in areas that need more thorough oral hygiene. While you might think you’re already practicing great oral hygiene, you might want to review the following tips to ensure you’re cleaning your teeth as well as you actually think you are. Because the bacteria under the gums in gingivitis is anaerobic, meaning that it lives in the absence of oxygen, getting oxygen into the area literally destroys the bacteria and helps halt the infection.

Brushing

  • Always use a soft-bristled toothbrush. Many people use a medium to stiff bristled brush, but these can actually cause more harm than good. Too much pressure during brushing can cause gum recession and enamel abrasion, leaving large wedges in the roots of the teeth.
  • Consider an electric toothbrush. High-quality electric brushes have soft bristles that are not only gentle on your teeth, but they also remove more plaque than manual toothbrushes, allowing you to clean your teeth and gums more efficiently. (4) Many electric toothbrushes also create a foaming action that helps penetrate areas under the gums and between the teeth, flushing out some of the bacteria.
  • Reassess your brushing method. Angle your toothbrush bristles at 45 degrees toward the gumlines. Focus on just two teeth at a time, and make short sweeping strokes back and forth. Only apply as much pressure as you need to cause the gums to slightly blanch. Too much pressure or the wrong angulation will not target gumline plaque and could cause gum recession.
  • Use a pure, anti-bacteria toothpaste. Conventional toothpastes are filled with potentially harmful ingredients. Even “natural” toothpastes have abrasives and other additives. The best choice is to use a 100% pure botanical toothpaste that is proven to kill the bacteria that lead to gum problems like gingivitis, without any of the harsh chemicals.

Flossing

flossing

  • Check your flossing technique. Flossing should not be simply taking a piece of floss and sliding up and down between the teeth several times. This can cause gum damage and does not target the plaque biofilm under the gums. Instead, wrap your floss in a “C” shape against each tooth, sliding up and down two to three times under the gumlines. This method protects the gums as well as helps remove debris that collects along the gum margin.
  • Think about using a water flosser. Water flossers are able to remove plaque deeply below the gums, between the teeth, and under hard to reach areas such as bridges or rough restorations that you might have problems cleaning with normal floss. (5) Water flossers are great for people with limited dexterity or simply don’t want to mess with floss in the first place. They are shown to reduce symptoms of gingivitis even more than some electric toothbrushes. (6)

Lifestyle Choices

  • Eat a balanced diet and get plenty of exercise. Eating the right foods, staying active and taking nutritional supplements can help strengthen your cardiovascular and immune systems, making it easier for your body to fight any infectious conditions.
  • Avoid tobacco. If you smoke, you are more likely to suffer from untreatable gum disease. Conditions like gingivitis may not be evident because the cigarette smoke causes blood vessels to atrophy, so you may never even be aware that you have a problem to begin with. Once the gingivitis progresses into periodontal disease it is nearly impossible to reverse unless you give up smoking.
  • Receive routine preventive care from your dentist. Having routine cleanings can remove any calcified bacterial deposits that would otherwise harbor conditions that encourage gingivitis. Your dentist can also identify any problem areas that may be susceptible to gingivitis, such as aging dental work or fillings with rough margins. If you have crowded teeth your dentist may recommend orthodontic therapy, which makes it easier to keep teeth clean and healthy.

Rinse with a pure mouthwash. When your mouth is trying to heal, it needs all the extra help it can get. Rinsing is one of the best ways to kill excess bacteria and help promote a healthy environment in your mouth. It’s best to rinse twice per day, after brushing and/or flossing. Be sure to swish and gargle thoroughly to help kill the bacteria in the entire mouth including the back of the tongue. It’s best to avoid alcohol-containing mouthwashes, because they can try out the mouth. A dry mouth is a breeding ground for bad bacteria, which cause gingivitis and other gum problems. Click here to learn more about rinsing with pure ingredients.

 

 

Treatment

dental-hygiene

Conventional Treatments
Most of the time your dentist will prescribe home techniques for you to use in order to heal your gingivitis symptoms. Sometimes symptoms can be so severe that there are more conventional treatments that need to be used.

Prescription Fluoride
Higher concentrations of fluoride are sometimes prescribed to help reduce tooth decay and encourage enamel remineralization, and they also may be used to address gingivitis symptoms. (7) The cost of prescription fluoride gel is typically around $15 and lasts for a long period of time as only a small portion is used each day. However, you should be aware of the potential dangers of fluoride When your mouth is trying to heal, it’s best to avoid potentially harmful ingredients such as fluoride, sls, and others. The best approach is to use pure, antibacterial ingredients that will empower your mouth to begin healing itself.

Prescription Mouthrinse
A prescription mouthrinse may be prescribed temporarily to reduce the inflammation associated with gum infections. These rinses cost more than over-the-counter products, but their ability to destroy bacteria makes them a popular tool for severe gum infection. However, these mouthrinses typically contain alcohol, which dries out the mouth. When the mouth is dry, it’s easier for harmful bacteria to grow and multiply again, potentially causing an even worse scenario in the long run. Gingivitis symptoms may go away for a while, but that does not necessarily mean they will not come back. Furthermore, many of the commonly used prescription mouth rinses will cause significant staining on the teeth if used for more than two or three weeks. For these reasons and more, it’s best to use a mouthrinse that does not contain alcohol and is also effective at destroying gingivitis-causing bacteria.

Routine Cleanings
Six-month prophylactic appointments with your hygienist are key to managing gingivitis symptoms. In some cases patients that experience poor gum health may need more frequent cleanings. Delaying cleanings can allow symptoms to worsen if oral hygiene isn’t up to par.

Orthodontic Therapy
Braces are an effective part of a comprehensive method used to treat symptoms of gingivitis and gum disease. Because crowded teeth are more likely to have bacteria buildup between them, moving them into a functionally correct position can make managing gingivitis symptoms much easier. Orthodontic therapy can cost several thousand dollars and take up to three years to complete, depending on your individual needs. (8)

Natural And Home Remedies
Natural remedies for gingivitis are typically the most effective means of managing, preventing and reversing the condition. When it comes down to how to treat gingivitis on your own, there are numerous resources available. The best person to help you stop gingivitis is you!

Home Remedies
Your oral home care routine is the most important part of treating gingivitis. Even your dentist will tell you that they can only do so much, but it will depend on what you do every day at home to help you keep your gums healthy. Using an electric toothbrush along with flossing or a water flosser will mechanically remove the bacteria from your mouth that causes gingivitis. Everything else is just a bonus! Other than the initial cost of your oral hygiene items, this method of cure is completely free. The best toothpaste to use is one that contains all-natural ingredients that have been proven to kill the bacteria that cause gingivitis.

Fluoride
Over-the-counter fluoride rinse may reduce the symptoms of gingivitis. It is extremely affordable but may not be as effective as prescription-strength fluoride gel. Keep in mind however that fluoride comes along with its own set of potential health dangers. It’s best to avoid fluoride and other chemicals such as sls and triclosan when your mouth is trying to heal.

Antiseptic Mouthwash
Most antiseptic mouth rinses are affordable and may help to reduce the symptoms of superficial or mild gum infections like gingivitis in the short run. However, rinsing with mouthwash does not remove bacteria from harder-to-reach areas under the gums or between teeth, which means rinsing is not a substitution for flossing. Some mouth rinses contain alcohol and cause dry mouth or burning sensations. A dry mouth can be a breeding ground for gingivitis-causing bacteria to multiply in the long run, thus defeating the purpose of the mouthwash. It’s best to use a non-alcohol mouthwash that contains ingredients that kill harmful bacteria.

Herbs And Natural Supplements
Studies show that various herbs and natural supplements can help not only provide removal of the bacteria that causes gingivitis, but can also alleviate symptoms. Some of these natural supplements include herbal additives or ingredients like pomegranate. (9) Herbal mouth rinses can be very effective in reducing gingivitis and inflammation of the gums. (10) In many cases these supplements are used in lieu of traditional oral hygiene products (toothpaste, mouthwash) and are shown to be extremely effective. (9, 11) They may be even more effective than other products. (12)

Essential oils can be very easy to use and make a significant impact on gum disease symptoms. (11) Some of these include:

Click here to learn more about the antibacterial toothpaste/mouthwash made of 100% pure almond, spearmint and peppermint oil
Here’s more essential oils benefits.

Probiotics supplements have long been used for various systemic health needs. Studies have also shown that they also reduce oral disease conditions such as those from gingivitis. (13)

Vitamin or Nutritional Supplements that increase the body’s immune health and support healing are useful when used along with other preventive measures. Some of the most beneficial supplements that are known to help heal gingivitis are:

  • CoQ10
  • Vitamin C
  • Vitamin A

Lifestyle Recommendations And Changes

The way you live, what you put into your body, and what you do with it all greatly affect your body’s ability to respond to infections like gingivitis.

Eat Healthy Foods
Fruits and vegetables contain nutrients that help your body’s immune system, and they also provide great stimulation for your gums while you chew.

Avoid Sugar And Processed Foods
Most processed foods contain refined sugars. When blood sugar levels rise it can cause an increase of inflammation, making it more difficult to treat gingivitis symptoms. The sugar also feed the bacteria in your mouth, creating an acidic environment that harbors oral disease.

Why Limiting Sugar Intake Holds The Key To Optimal Dental Health

Exercise
Get your body to respond by getting up and getting your blood pumping. That doesn’t necessarily mean you need to become a bodybuilder. Simple activities like walking 30 minutes each day can be very beneficial!

Give Up Tobacco And Alcohol
Tobacco use hides the symptoms of gum disease, as well as prevents most treatment methods from reversing it. Alcoholic beverages contain high amounts of sugar, which promotes a breeding ground in your mouth for bacteria. Not only is it bad for your gums, it also leads to higher rates of tooth decay.

 

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Your Questions About Gingivitis Answered

Is gingivitis curable?
Yes. Gingivitis is a reversible inflammatory condition. The initial reaction is a sign of infection in that area of the gums due to plaque biofilm. However, when left untreated, gingivitis can turn into periodontal disease and result in tooth mobility or loss. It is easiest to cure the gum infection while it is still in the early stages (gingivitis). When treated effectively, gingivitis is completely curable.

Can you reverse gingivitis?
Yes. Proper oral hygiene and counteractive care to eliminate the disease bacteria from your mouth can lead to complete reversal of gingivitis. Unfortunately if gingivitis is allowed to persist it can develop into periodontal disease. Periodontal disease can be treated, but not reversed. It may also lead to tooth mobility and loss due to the destruction of bone support. Gingivitis only affects the superficial gum tissue and can be reversed!

Is gingivitis contagious?
The advanced form of gingivitis, periodontal disease, can be contagious and passed between family members due to the bacterium in saliva. Sharing eating utensils or kissing can allow these bacteria to pass back and forth between persons, increasing the risk of developing gum infections. However, gingivitis is preventable and can only begin to develop in mouths that are not cleaned properly or in people who have suppressed immune systems.

When does gingivitis turn into periodontal disease?
Gingivitis is simply the inflammation and infection of the superficial gum tissue. When gingivitis is allowed to persist, the bacteria are targeted by the immune system, which sends antibodies to the area. These antibodies cross the connective tissue, which causes the loss of attachment of both gum tissue and bone. Bone is lost as a result and deep pockets develop under the gum tissue. It is at this point when the condition becomes periodontal disease.

How long does it take to develop gingivitis?
Gingivitis can usually develop in just a few days or over several weeks. Because it can be gradual, it may be more difficult to notice for people that don’t pay much attention to their oral hygiene – especially teenagers.

How long does it take to cure gingivitis?
Classic gingivitis symptoms take approximately 10 to 14 days to heal. Even with proper treatment the conditions will continue to exist for several days. Be patient and wait at least two weeks before expecting complete reversal of symptoms. If your gums do not seem to be healing, you may have periodontal (gum) disease and need professional care to cleanse the area.

Oral hygiene hurts my gums. How else can I treat the area?
Cleansing areas of gingivitis will almost always cause you to be sensitive. Remember, if your gums are healthy they will not bleed. If you are brushing and flossing correctly, you will most likely experience some discomfort or bleeding while gingivitis exists. Stick with an efficient oral hygiene routine that includes flossing, toothbrushing and supplements, and expect your tenderness or other symptoms to subside within about two weeks.

My gums are still bleeding. Could I have something other than gingivitis?
It is quite possible that even with effective care you could still experience bleeding during brushing or flossing. If you are anemic consider taking an iron supplement and watching your diet more closely. Some areas such as crowns or old fillings may have margins that harbor more bacteria than others, making them slower to respond to care. If you have developed periodontal disease or large amounts of tartar you ought to have a professional cleaning and screening to determine if there is bone loss around the area.

Kill the bacteria that cause gingivitis. Click here to find out how.

 

References:

  1. Amabile N., Susini G., Pettenati-Soubayroux I., Bonello L., Gil J-M., Arques S., Bonfil J.J., Paganelli F.; (2008). Severity Of Periodontal Disease Correlates To Inflammator Systemic Status And Independently Predicts The Presence And Angiographic Extent Of Stable Coronary Artery Disease.; Journal of Internal Medicine, 263, 6, 644-652.
  2. S, Kebschull M, Deschner J.; Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. [Relationship Between Periodontitis And Systemic Diseases].[Article in German] 2011 Sep;54(9):1089-96.
  3. Zuo Z, Jiang J, Jiang R, Chen F, Liu J, Yang H, Cheng Y.;Effect Of Periodontitis On Erectile Function And Its Possible Mechanism.; J Sex Med. 2011 Sep;8(9):2598-605.
  4. Moritis K, Jenkins W, Hefti A, Schmitt P, McGrady M.; A Randomized, Parallel Design Study To Evaluate The Effects Of A Sonicare And A Manual Toothbrush On Plaque And Gingivitis.; J Clin Dent. 2008;19(2):64-8.
  5. Barnes CM, Russell CM, Reinhardt RA, Payne JB, Lyle DM.;Comparison Of Irrigation To Floss As An Adjunct To Tooth Brushing: Effect On Bleeding, Gingivitis, And Supragingival Plaque.; J Clin Dent. 2005;16(3):71-7.
  6. Goyal CR, Lyle DM, Qaqish JG, Schuller R.; The Addition Of A Water Flosser To Power Tooth Brushing: Effect On Bleeding, Gingivitis, And Plaque.; J Clin Dent. 2012;23(2):57-63.
  7. He T, Barker ML, Goyal CR, Biesbrock AR.; Anti-gingivitis Effects Of A Novel 0.454% Stabilized Stannous Fluoride Dentifrice Relative To A Positive Control.; Am J Dent. 2012 Jun;25(3):136-40.
  8. Harrel SK, Nunn ME; The Effect Of Occlusal Discrepancies On Periodontitis. II. Relationship Of Occlusal Treatment To The Progression Of Periodontal Disease.; J Periodontology, (April 2001) 72, 4, 495—505.
  9. Somu CA, Ravindra S, Ajith S, Ahamed MG.; Efficacy Of A Herbal Extract Gel In The Treatment Of Gingivitis: A Clinical Study.; J Ayurveda Integr Med. 2012 Apr;3(2):85-90.
  10. Samuels N, Grbic JT, Saffer AJ, Wexler ID, Williams RC.; Effect Of An Herbal Mouth Rinse In Preventing Periodontal Inflammation In An Experimental Gingivitis Model: A Pilot Study.; Compend Contin Educ Dent. 2012 Mar;33(3):204-6, 208-11.
  11. Charles CA, Amini P, Gallob J, Shang H, McGuire JA, Costa R.; Antiplaque And Antigingivitis Efficacy Of An Alcohol-Free Essential-Oil Containing Mouthrinse: A 2-Week Clinical Trial.; Am J Dent. 2012 Aug;25(4):195-8.
  12. Kraivaphan P, Amornchat C.; Effect Of An Essential Oil-Containing Dentifrice On Established Plaque And Gingivitis.; Southeast Asian J Trop Med Public Health. 2012 Jan;43(1):243-8.
  13. Saha S, Tomaro-Duchesneau C, Tabrizian M, Prakash S.; Probiotics As Oral Health Biotherapeutics.; Expert Opin Biol Ther. 2012 Sep;12(9):1207-20. Epub 2012 Jun 13.

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