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Gingivitis

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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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

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
  • Increased age
  • Pregnancy
  • Birth control pills
  • Family members with gum disease
  • Sex: male
  • 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 held at a 45-degree angle to the line where your teeth and gums meet. An electronic toothbrush may make brushing easier for patients with physical limitations. Replace the brush 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 tight. 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 recommend 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, accumulated 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:
    • Brushing teeth twice daily with a fluoride toothpaste. There is some data that rotating oscillating electric toothbrushes are more effective in controlling gingivitis than “normal” brushing by hand.
    • Flossing at least once a day
    • Visiting the dentist's office for a cleaning at least every six months
  • Eating balanced, nutritious meals
  • Not smoking
  • Avoiding alcohol

Revision Information

  • American Academy of Periodontology

    http://www.perio.org

  • American Dental Association

    http://www.ada.org

  • Canadian Dental Association

    http://www.cda-adc.ca

  • Canadian Dental Hygienists Association

    http://www.cdha.ca

  • Academy of General Dentistry website. Available at: http://www.agd.org/support/articles/?ArtID=1250. Updated February 2007. Accessed July 27, 2011.

  • American Academy of Periodontology website. Available at: http://perio.org/consumer/types-gum-disease.html. Updated June 2010. Accessed July 27, 2011.

  • American Dental Association website. Available at: http://www.ada.org.

  • Gingivitis. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/gingivitis/DS00363. Updated November 2010. Accessed July 27, 2011.

  • 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.