What is Gingivitis? Causes, Symptoms and Treatment

General Medical Topics

Dental examination examination to determine gingivitis in young female patient

Our pearly whites are the star of the show and our gums are often forgotten. But if we don’t look after our gums, we’re failing our teeth too. 

Neglected gums can develop gingivitis which can go on undetected until there are major problems affecting the gum, tissue, teeth, and even the bone that holds the teeth in place. 

What is Gingivitis?

Gingivitis is inflammation of the gum margins around the teeth.Gingivitis is caused by a build-up of plaque on teeth and around the gum line. The bacteria in plaque can irritate the gums causing them to become inflamed. Gingivitis is the first stage of periodontal disease, a serious inflammatory condition. Around 20% of Australian adults have gingivitis and 22% of children aged 5-14 years. 

What are the Causes of Gingivitis?

There’s a wide range of risks and causes of gingivitis. Some are common to the entire population and others only a small percentage. 

Poor Oral Hygiene - The primary cause of gingivitis is poor oral health. If people brush their teeth twice a day, they will remove the bacterial film on their teeth which leads to a buildup of plaque and tartar. Not seeing a dentist every six months means teeth aren’t being professionally cleaned to remove the hardened plaque.  

Poor Health – Those people who suffer from a chronic disease such as cancer or HIV have a weakened immune system which makes gum disease more likely. People living with diabetes are also more prone to problems with their gums. Even a poor diet can put people at greater risk.   

Crooked Teeth – When teeth are crowded they’re difficult to clean with a toothbrush. Although many people with crooked teeth are able to clean their teeth effectively and avoid significant gingivitis, plaque is more likely to build up on teeth and around the gum line which can lead to gingivitis. Avoiding gingivitis is one reason people undergo orthodontic treatment. Braces and Invisalign straighten teeth so they’re easier to keep clean and attract less plaque. 

Hormonal Changes – Women who are pregnant or take an oral contraceptive are more at risk of developing gingivitis. Moreover children who are going through puberty often have an exaggerated inflammatory response in their gums to small build ups of plaque so it's really important to clean thoroughly around the braces to minimize the chances of developing gingivitis.

Family History – A parent or sibling with gingivitis or periodontitis makes a person at greater risk of suffering the same. 

Smoking - The gum tissue in smokers struggles to repair itself as it can in non-smokers and the real issue is that the orthodontists cannot accurately detect gum disease in smokers because the blood vessels become scarred in the gums and do not bleed when they are infected. Checking for bleeding with gum probes is the primary method by which dentist assess gum health.

Medications – Some medications reduce the amount of saliva the body produces which helps protect teeth and gums. Other drugs have the side effect of causing abnormal growth of gum tissue.

Symptoms of Gingivitis

In the early stages of gingivitis, the signs are subtle and often aren’t even noticeable to many people. They may have swollen, red gums that bleed or bad breath. As the disease worsens and turns into periodontal disease or what is called “periodontitis”, the signs become more obvious.

How Do You Prevent Gingivitis?

Many cases can be avoided with basic oral hygiene. 

  • Brush your teeth thoroughly for two minutes twice a day

  • Floss between teeth daily

  • Visit the dentist every six months

How Do You Treat Gingivitis?

Once plaque has hardened, it’s impossible to remove by brushing at home and requires a professional. A dentist can remove the hardened plaque on teeth and around the gumline. Sometimes a dentist needs to do deep cleaning to remove plaque from below the gum line. If gums are infected, an antibiotic may be prescribed.  

Once your teeth are clean, you can keep the plaque at bay by twice daily brushing at home. You may also use an antiseptic mouthwash to reduce bacteria that causes plaque. If you don’t think your brushing technique is effective, ask your dental hygienist to show you how. 

A dentist may advise a patient that their gingivitis is advanced and they now have periodontal disease. They may refer their patient to a periodontist for further treatment. A periodontist specialises in the prevention, diagnosis, and treatment of gum problems. Periodontists can perform minor oral surgery to repair gum damage with soft tissue grafts and perform dental implants on patients who have lost teeth. 

Gum Disease and Orthodontic Treatment 

When we move teeth with orthodontic appliances, we stretch the gum attachment to the teeth and dissolve the bone surrounding the teeth. This gum and bone then has to heal and stabilise once the tooth movement has ceased. It's possible that the gum attachment may be lost and the bone may not grow back if teeth are moved in the presence of gingivitis or periodontitis. Your gums and dental health could be worse than when you started treatment.

Orthodontic patients may have to delay the fitting of their braces if they have gum disease. Any movement of teeth in infected gums can cause irreparable damage. If a patient with braces or Invisalign develops gum disease, treatment should cease until the infection has been resolved by your dentist or periodontist.  

It’s important to develop good oral hygiene habits before, during and after any orthodontic treatment to protect your smile. If you notice any changes with your gums or sign of gum disease, speak to your dentist or orthodontist. 

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Are There Any Complications of Gingivitis?

When gingivitis is left untreated, symptoms can worsen as gums continue to deteriorate with bleeding, recession and possibly abscesses forming. The infection in the gum can enter the bloodstream and cause serious health problems. 

Periodontal Disease

Gingivitis is the first stage of periodontal disease. Unfortunately, periodontal disease isn’t well-known and most people don’t know they have it until they’ve experienced permanent damage to their teeth, gums and bone. 

The percentage of adults suffering periodontitis increases in each age group. For the 15-34 year age group 7.4% have periodontitis and increases to 25% amongst 35-54 year old’s, it jumps to 44% for those aged 55-74 and 61% in those aged 75 years and older.  

Necrotizing ulcerative gingivitis (NUG)

Known as Trench Mouth because it was common amongst soldiers during WW1, most probably due to malnutrition, poor oral hygiene and psychological stress. The painful ulcerations, bad breath and bleeding gums is a form of periodontal disease. Basic oral hygiene and access to regular dental care means NUG isn’t common in developed nations. 

Chronic Disease

Gum disease has been labelled the silent killer as it can cause inflammatory substances in the blood that worsen chronic health conditions. It has been linked to heart disease, cancers, strokes, babies born preterm or stillborn. People with gum disease have two to three times the risk of heart disease and stroke.

If you have any oral hygiene queries, don’t hesitate to call a therapist at our clinic’s, or contact us online -  we’re always happy to help.