(Top photo) Severe gingivitis before treatment (Bottom photo) After mechanical removal of plaque and calculus.

Gingivitis is inflammation of the gums (gingiva). It is often caused by a thin layer of bacteria that accumulates on the teeth – plaque. Gingivitis is not a destructive type of periodontal disease. If left untreated, however, gum inflammation can progress to periodontitis, which is more serious and can eventually lead to tooth loss.

A patient with gingivitis has red and swollen gums that most likely bleed when the teeth are brushed. Usually, gingivitis is avoided with good oral hygiene – brushing longer and more often, as well as using dental floss.

In mild cases of gingivitis, patients may not even know they have it because the symptoms are mild. However, it should be given serious attention and action taken.

Causes of gum disease:

Gum disease caused by dental plaque

• Gingivitis caused by plaque alone
• Gingivitis is caused by multiple factors
• Gingivitis caused by drugs
• Gingivitis caused by malnutrition
• Gum disease – caused by a specific bacteria
• Gum disease – caused by a specific virus
• Gum disease – caused by a specific fungus
• Gum disease – caused by genetic factors
• Gingivitis caused by systemic conditions
• Inflammation of the gums caused by traumatic injuries
• Inflammation of the gums caused by a reaction to foreign bodies
• Inflammation of the gums, without known causes

What are the signs and symptoms of gingivitis?

A symptom is something that the patient can feel and describe (gum pain), while a sign is something that everyone, including the doctor or nurse, can see (swelling).

In mild cases of gingivitis, there may be no discomfort or visible symptoms.

Signs and symptoms of gingivitis may include:

• The gums are bright red or purple
• The gums are tender and sometimes painful to the touch
• Gums bleed easily when brushing or flossing
• Halitosis (bad breath)
• Inflammation (swollen gums)
• Shifting gums
• Soft gums
• What are the causes of gingivitis?
• Plaque and tartar build-up

The most common cause of gum inflammation (gingivitis) is the build-up of bacterial plaque between and around the teeth, which triggers an immune response, which in turn can lead to the destruction of the gum, and ultimately further complications, including loss on teeth.

Dental plaque is a thin layer of microorganisms that naturally accumulate on the teeth. It is usually formed by colonies of bacteria that try to stick to the smooth surface of the tooth. Plaque can also cause tooth decay and periodontal problems such as gingivitis and chronic periodontitis.

When plaque is not adequately removed, it causes tartar to build up, at the base of the teeth, in the gum area. Tartar is more difficult to remove and can only be removed by a dentist.

Gingivitis can have other causes, including:

• Hormonal changes – which can occur during puberty, menopause, the menstrual cycle, and pregnancy. The gums can become more sensitive and the risk of inflammation increases.
• Certain diseases such as cancer, diabetes, and HIV are associated with a higher risk of developing gingivitis.
• Medicines – oral health can be affected by some medicines, especially if salivation is reduced. Anticonvulsants and some angina medications can cause abnormal growth of gum tissue.
• Smoking – regular smokers are more likely to develop gingivitis than non-smokers.
• Hereditary – Experts say that people whose parent(s) has/had gingivitis have a higher risk of developing it themselves.

Diagnosis of gingivitis

Through frequent oral hygiene checks and gingivitis symptoms such as plaque and tartar in the oral cavity. A check for signs of periodontitis may also be recommended; this can be done by x-ray or periodontal examination as well as microbiological examination.

What are the treatment options for gingivitis?

If the patient is diagnosed early and the treatment is quick and correct, inflammation of the gums can be successfully stopped. The treatment is done only by a dentist, as it can cause injury to the tooth surface when it is removed by a non-professional. After that, procedures performed by the patient at home are done.

Treatment of gingivitis at the dentist:

• Plaque and tartar are cleaned. Some patients may find cleaning unpleasant, especially if the tartar build-up is large or the gums are very sensitive
• The dentist explains to the patient the importance of oral hygiene and how to effectively brush and floss his/her teeth
• Periodically examine the patient, with additional cleaning if necessary
• Treating the teeth so that oral hygiene is maintained effectively. Certain dental problems, such as crooked teeth, ill-fitting crowns or bridges, can make it harder to remove plaque and tartar (they can also irritate the gums)

What the patient can do at home:

• Brush your teeth at least twice a day
• Note that in most cases, electric toothbrushes do a better job
• Floss your teeth at least once a day
• Rinse your mouth regularly with mouthwash. Ask your dentist to recommend one

What are the possible complications of gingivitis?

In the majority of cases, if gingivitis is treated and the patient follows the dental professional’s instructions, there are no complications. However, if the condition is left untreated, gum disease can spread and affect the tissues, teeth and bones, leading to periodontitis.

Possible complications of gingivitis can include:

• Abscess in the gums
• Abscess in the jaw bones
• Infection in the jawbone or gums
• Periodontitis – this is a more serious condition that can lead to tooth loss
• Recurrent gingivitis
• Gum disease is caused by a bacterial infection

Several studies have linked gum disease such as periodontitis to cardiovascular disease, including heart attack or stroke. Other reports have associated them with a risk of lung disease.

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