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Gingivitis

(Gum Disease)

Definition

Gingivitis is a mild, often reversible form of gum disease. If left untreated, gingivitis can progress to a serious condition called periodontitis.
Gingivitis
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Copyright © Nucleus Medical Media, Inc.

Causes

A substance that forms on teeth called plaque causes gingivitis. Plaque is a sticky material, composed of bacteria, mucus, food, and other substances. It hardens to form tartar or calculus. When plaque is left on the teeth for an extended period of time, it can lead to gingivitis. Toxins produced by bacteria in dental plaque irritate the gum tissue and cause infection, inflammation, and pain.

Risk Factors

Gingivitis is more common in older adults, especially men.
Factors that increase your risk of gingivitis include:
  • Poor brushing and flossing
  • Stress
  • Clenching teeth together or grinding teeth
  • Poor nutrition
  • Diabetes
  • Breathing through the mouth
  • HIV infection
  • Improper bite
  • Pregnancy
  • Birth control pills
  • Family members with gum disease
  • Poorly fitting dentures
  • Some medications taken for high blood pressure, heart disease, and depression
  • Some seizure medications
  • Drinking alcohol
  • Smoking
  • Down syndrome

Symptoms

Gingivitis is often painless with symptoms developing when it becomes worse.
Symptoms may include:
  • Swollen, puffy gums
  • Tender gums
  • Redness in the gums or around the teeth
  • Bleeding gums during brushing or eating
  • Gum tissue that recedes or changes shape
  • Persistent bad breath

Diagnosis

The dentist will examine your teeth and gums, assessing them for swelling and areas where the tissue is pulling away from the teeth, forming a pocket. Early diagnosis of the problem enables prompt treatment and the possibility of reversing the condition. It is important to see your dentist every six months for a cleaning because gingivitis may have no symptoms in the early stages.

Treatment

Gingivitis therapy aims to remove the irritating plaque and prevent its return.
Treatment includes:
  • Regular dental checkups and good oral hygiene
  • Careful and frequent brushing and flossing
  • A healthful diet that is low in saturated fat and rich in whole grains, fruits, and vegetables

Self-care

Brushing
Thoroughly brush and floss your teeth with a fluoride toothpaste. Use a soft-bristled toothbrush or a powered toothbrush held at a 45-degree angle to the line where your teeth and gums meet. Replace the brush or powered toothbrush bristles when the bristles become bent, frayed, or every 3-4 months. Move the brush in small circular movements along the gumline and chewing surfaces of your teeth.
Flossing
Brushing removes bacteria from the teeth, but the brush cannot reach everywhere. Flossing helps get rid of food and bacteria between teeth. Hold the floss tightly. Gently bring it down between the teeth. Do not pop the floss against the gum. Curve the floss around the tooth and rub up and down. Adjust the floss, so you use a fresh section for each tooth, including the back side of the last tooth, left and right, upper and lower.
Other Self-care
The dentist may advise additional self-care treatments, such as massaging the gums with a rubber tip. Rinses to fight bacteria and plaque build-up may help some patients.

Dental Care

Dental health professionals check for gingivitis and remove plaque that has built up on teeth. A visit every six months is usually considered adequate. Patients with gingivitis may need more frequent cleanings. If the disease progresses and plaque builds up below the gum line, the area must be scraped off and smoothed with dental tools. Otherwise, plaque and tartar buildup make it easier for bacteria to grow.
If an area has progressed to periodontal disease, surgery or medication may be required. Treating an underlying medical problem may improve the health of your gums.
In patients with recurring or persistent gingivitis, the dentist will evaluate whether some other condition may be contributing to the gum disease.

Prevention

Strategies to prevent gingivitis include:
  • Good dental habits:
    • Brush your teeth and tongue with fluoride toothpaste at least two times per day.
    • Use a soft-bristled toothbrush or a powered toothbrush.
    • Floss at least once a day.
    • See your dentist as advised for regular cleanings and check-ups.
  • Eat balanced, nutritious meals.
  • Avoid smoking.
  • Avoid alcohol.

RESOURCES

American Academy of Periodontology http://www.perio.org

Mouth Healthy—American Dental Association http://www.mouthhealthy.org

CANADIAN RESOURCES

Canadian Dental Association http://www.cda-adc.ca

Canadian Dental Hygienists Association http://www.cdha.ca

References

Gingivitis. Mouth Healthy—American Dental Association website. Available at: http://www.mouthhealthy.org/en/az-topics/g/gum-disease. Accessed September 29, 2014.

Periodontal (gum) disease: causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/oralhealth/topics/gumdiseases/periodontalgumdisease.htm. Updated August 2012. Accessed September 29, 2014.

Taking care of your gums. JAMA patient page. JAMA. 2000;284:1472.

4/7/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Weyant RJ, Tracy SL, et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013;144(11):1279-1291.

7/15/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Yaacob M, Worthington HV, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014 Jun 17;6.

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