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What is gingivitis? What causes gingivitis?

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Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of bacteria that accumulate on the teeth – plaque; this type is called plaque-induced gingivitis. Gingivitis is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress to periodontitis, which is more serious and can eventually lead to loss of teeth.

A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. Generally, gingivitis resolves with good oral hygiene – longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.

In mild cases of gingivitis, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately.

What are the signs and symptoms of gingivitis?

A symptom is something the patient feels and describes, such as painful gums, while a sign is something everybody, including the doctor or nurse can see, such as swelling.

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

Signs and symptoms of gingivitis may include:

  • Gums are bright red or purple
  • Gums are tender, and sometimes painful to the touch
  • Gums bleed easily when brushing teeth or flossing
  • Halitosis (bad breath)
  • Inflammation (swollen gums)
  • Receding gums
  • Soft gums

What are the causes of gingivitis?

The accumulation of plaque and tartar

The most common cause of gingivitis is the accumulation of bacterial plaque between and around the teeth, which triggers an immune response, which in turn can eventually lead to the destruction of gingival tissue, and eventually further complications, including the loss of teeth.

Dental plaque is a biofilm that accumulates naturally on the teeth. It is usually formed by colonizing bacteria that are trying to stick to the smooth surface of a tooth. Some experts say that they might help protect the mouth from the colonization of harmful microorganisms. However, dental plaque can also cause tooth decay, and periodontal problems such as gingivitis and chronic periodontitis.

When plaque is not removed adequately, it causes an accumulation of calculus (tartar – it has a yellow color) at the base of the teeth, near the gums. Calculus is harder to remove, and can only be removed professionally.

Plaque and tartar eventually irritate the gums.

Gingivitis may also have other causes, including:

  • Changes in hormones – which may occur during puberty, menopause, the menstrual cycle and pregnancy. The gingiva may become more sensitive, raising the risk of inflammation.
  • Some diseases – such as cancer, diabetes, and HIV are linked to a higher risk of developing gingivitis.
  • Drugs – oral health may be affected by some medications, especially if saliva flow is reduced. Dilantin (anticonvulsant), and some anti-angina medications may also cause abnormal growth of gum tissue.
  • Smoking – regular smokers more commonly develop gingivitis compared to non-smokers.
  • Family history – experts say that people whose parent(s) has/had gingivitis, have a higher risk of developing it themselves.

What are the treatment options for gingivitis?

If the patient is diagnosed early on, and treatment is prompt and proper, gingivitis can be successfully reversed.

Treatment involves care by a dental professional, and follow-up procedures carried out by the patient at home.

Gingivitis care with a dental professional:

  • Plaque and tartar are removed. This is known as scaling. Some patients may find scaling uncomfortable, especially if tartar build-up is extensive, or the gums are very sensitive.
  • The dental professional explains to the patient the importance of oral hygiene, and how to effectively brush his/her teeth, as well as flossing
  • Periodically following-up on the patient, with further cleaning if necessary
  • Fixing teeth so that oral hygiene can be done effectively. Some dental problems, such as crooked teeth, badly fitted crowns or bridges, may make it harder to properly remove plaque and tartar (they may also irritate the gums).

What the patient can do at home:

  • Brush your teeth at least twice a day
  • Bear in mind that in most cases, electric toothbrushes do a better job than we can do on our own
  • Floss your teeth at least once a day
  • Regularly rinse your mouth with an antiseptic mouthwash. Ask your dentist to recommend one.
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How many teeth have you lost? The number of teeth we have could tell us how long we’ll live…

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Tooth loss can be used as a major predictor to somebody’s life expectancy, according to new research.

The research, published in the Periodontology 20001, found that the number of teeth we lose can be a key indicator to our quality of life and that those who have a full set of teeth when they are 74 are significantly more likely to reach 100 years old2.

The study shows that there was a clear evidence that tooth loss is closely related to ‘stress’ during a person’s lifetime. This includes a person’s specific social, emotional, economic and educational experiences as well as health issues such as chronic disease, genetic conditions, nutritional intake and lifestyle choices.

Evidence showed that people who had lost five or more teeth by the age of 65 were also more likely to suffer from other serious health issues such as cardiovascular disease, diabetes and osteoporosis which could severely limit a person’s life expectancy. Many of these illnesses have been previously linked to as person’s quality of life and their socio-economic status.

With such a close relationship between our oral health and quality of life, leading health charity, the Oral Health Foundation, is encouraging people to ensure they pay close attention to the health of their mouth and visit their dental team regularly to check for any signs of disease which could lead to tooth loss.

Speaking on the issue Dr Nigel Carter OBE, CEO of the Oral Health Foundation, said: “There are many reasons why somebody can lose their teeth, it could be down to trauma, smoking or just a continued poor oral health routine, it can also be related to gum disease which is closely linked to health conditions such as heart disease and diabetes.

“What this piece of research suggests is that tooth loss can often be a signifier of a poor quality of other areas of a person’s lifestyle and therefore a higher likelihood of someone having health issues because of this.

“Importantly it also shows that diseases associated with tooth loss, such as gum disease, can also contribute to an increased risk of life limiting diseases.

“It is very evident that what is going on in our mouths can really be a useful window to our overall health. It is therefore vital that we take proper care of our mouth and pay close attention to what is happening as it could be a sign of something more serious.”

The charity is urging people to abide by three simple rules for looking after their oral health; brush your teeth last thing at night and at least one other time during the day with a fluoride toothpaste; cut down on the amount of sugary foods and drinks and how often you have them and visiting your dentist regularly, as often as they recommend, by doing so it is possible to help prevent disease, not only in the mouth but the whole body too.

Dr Carter added; “Tooth loss itself comes with its own problems, it can lead to issues with eating and therefore a person’s ongoing nutrition and even create problems with their ability to communicate.

“We welcome more research into this matter as it may be a way to detect and prevent diseases related to tooth loss and other serious systemic diseases.”

Article Sources

1. Friedman PLamster I. Tooth loss as a predictor of shortened longevity: exploring the hypothesis. Periodontology 2000. 2016;72(1):142-152.

2. Kaufman L, Setiono T, Doros G, Andersen S, Silliman R, Friedman P et al. An Oral Health Study of Centenarians and Children of Centenarians. Journal of the American Geriatrics Society. 2014;62(6):1168-1173.