Gingivitis – Guide

So you’re having some gum problems and you think it may be gingivitis? We’re going to explain what it is and what you need to do to properly treat this dental condition.

Overview

Gingivitis is the first stage of gum disease and its hallmark trait is gum inflammation.

When the gums are inflamed, they become red, swollen, and will bleed easily. This is the result of untreated bacterial plaque and tartar build up which causes inflammation when they’re left in close proximity to the gingiva (gums).

The sight of bleeding gums should motivate you to get it treated by a dentist. However, if it doesn’t, perhaps the fact that untreated gingivitis can progress to the next stage of gum disease called periodontitis will.

The gum inflammation can spread from the gums to the surrounding periodontium. Once that happens you will start losing bone around the teeth and the ultimate result will be loose teeth. If the dentition loses enough bone they may even fall out on their own. The unfortunate news is that bone loss from periodontitis is irreversible.

Therefore if you don’t want to lose all of your teeth to gum disease, you’d do well to listen carefully to what we have to say.

Prevalence

A study by The Journal of Dental Research found that periodontal disease affected 47% of the US population. The incidence only increased with older age.

Other statistics for gum disease:

• More common in Men vs Women (56.4% vs 38.4%)
• Those living below the poverty level (65.4%)
• Those with less than a high school degree (66.9%)
• Smokers are at greater risk (64.2%)

Symptoms

If you have gingivitis, your body does a great job of presenting signs and symptoms to let you know to seek medical help.

Signs of gum disease:

• Bad breath. Halitosis is very common in those with gum disease due to the bacteria producing significant quantities of VSC (volatile sulphur compounds.)
• Bad taste. A mix of bleeding and bacterial byproducts can cause a foul taste.
• Bleeding gums. Provoked (while brushing or flossing) or unprovoked bleeding (spontaneous). The latter is an indication of a more advanced stage of gingivitis.
• Loose gums. They look like they’re peeling away from your teeth.
• Loose teeth. The teeth are mobile and you can wiggle them.
• Painful to chew. Discomfort when you’re eating.
• Tender or painful gums. They feels sore or tender when you brush and floss.
• Red swollen gums. Tell-tale signs of inflammation are gums that red and swollen.
• Sensitive teeth. Teeth feel sensitive when eating cold, hot, sweet or acidic foods.
• Your bite feels weird. There’s been are change in how your teeth come together.
• Your denture fits differently. Your false teeth don’t seem to fit as well.

When to see a dentist

If you’re experiencing any of these signs or symptoms, it means that you should schedule a dental consultation. Even if it turns out that you don’t have gingivitis, these are still issues that you need to address.

Causes

Gingivitis is caused by unmanaged oral bacteria that is left untreated for an extended period of time which results in gum inflammation.

Mechanism for gum inflammation

Bacteria aggregate together into a thin sticky film called plaque which adheres to the surfaces of your teeth. Plaque is soft and can be easily removed by gentle brushing, flossing, and rinsing. When not removed it will grow in size and can calcify into tartar (calculus).

Once the plaque turns hard and calcifies into tartar, you cannot remove it with at home oral care (brushing, flossing, rinsing). Only a dentist can get it off with a teeth cleaning.

• Tartar is recognized as a foreign substance by the body.
• Your immune system induces an inflammatory response to try to get rid of the tartar.

In summary, the accumulation of plaque and tartar that is not removed will cause the gums to become inflamed.

Risk factors

These are risk factors for gum disease, both gingivitis and periodontitis:

• Diabetes.
• Dry mouth. Xerostomia results in a decrease of salivary flow which leads to greater bacterial retention and plaque.
• Genetics. If your parents have it, you may be more prone.
• Inadequate oral hygiene. Poor oral care habits will lead to plaque and tartar build up.
• Ill fitting dental restorations. Restorations such as fillings and crowns that are poorly contoured can be a plaque trap.
• Improper dental appliances. This includes dentures and retainers.
• Immune disorders. HIV/AIDs or cancer treatment compromises the immune system.
• Older age. As we age our hand dexterity worsens. This can lead to inadequate oral hygiene since we won’t be able to brush or floss as effectively.
• Poor nutrition. Vitamin C deficiency can lead to a condition called scurvy where the gums bleed profusely.
• Pregnancy. The hormonal changes while carrying a baby can increase the risk for gum disease. In fact there is a condition called pregnancy gingivitis.
• Smoking. Smoking increases severity of periodontal disease. That includes chewing and smoking tobacco.
• Severe crowded teeth. Straight teeth don’t just improve your smile, they also make them easier to clean. Severe crowding can make it difficult to brush and floss.

Taking certain medications can be contributory:

• Anticonvulsants – phenytoin (Dilantin, Phenytek)
• Anti-virals
• Anti-fungals
• Calcium channel blockers
• Chemotherapy
• Oral contraceptives
• Steroids

Is it contagious?

Technically, gingivitis and periodontal disease in general is NOT contagious because the inflammation is due to your body’s reaction to the existing bacteria. With that being said, the gum disease causing bacteria CAN be transmitted via exchanging saliva.

• Sharing foods
• Using same utensils

Is periodontal disease contagious?

“Research has shown that periodontal disease is caused by the inflammatory reaction to bacteria under the gums, so periodontal disease technically may not be contagious. However, the bacteria that cause the inflammatory reaction can be spread through saliva. This means that if one of your family members has periodontal disease, it’s a good idea to avoid contact with their saliva by not sharing eating utensils or oral health equipment. If you notice that your spouse or a family member has the warning signs of a possible periodontal problem (bleeding, red and swollen gums, or bad breath) you may want to suggest that they see the periodontist for an exam. It may help to protect the oral health of everyone in the family.”

American Academy of Periodontology

Diagnosis

Gingivitis can only be diagnosed by a dentist and they use a combination of clinical factors to come to that conclusion.

• Clinical exam. Do the gums look red and poofy like they’re swollen?
• Gingival bleeding. When you touch the gums do they bleed easily?
• Measure pocket depth. Your dentist will use a perio probe to measure the depth of the periodontal pocket. The measurement is in millimeters.
  • 1-3 mm = normal
  • 4-6 mm = mild to moderate inflammation
  • 7-10+ mm + severe inflammation
• Attachment loss. Do the teeth have a lot of bone loss or gum recession?
• Furcation involvement. Is the furcation of the molars involved or exposed?
• Tooth mobility. Are the teeth mobile or are they strong and sturdy?
• Dental x-rays. Taking routine x-rays can show the levels of the bone as well as the calculus that may be present. The more bone loss and tartar that are present, the more severe the disease.

If there are more yes than nos for the findings above, you will most likely be diagnosed with gingivitis.

Treatment

Treating and managing gingivitis is two-fold because it requires professional treatment with a dentist and at home care.

Your dentist will help you get back on track but it is up to you to maintain your the health of your mouth. After all, your dentist only sees you two days a year but the other 363 days of the year is all up to you.

Professional treatment

• Dental cleaning. Mild gingivitis can be sufficiently treated with a regular teeth cleaning. This is the routine cleaning (prophylaxis) that you get every six months and it involves cleaning above the gum line.
• Deep teeth cleaning. Moderate to severe gingivitis where a lot of calculus is present may require a deep cleaning. This is a regular dental cleaning plus scaling and root planing below the gum line. This may need to be split up into two separate appointments.
• Antibiotic mouthwash. Your dentist may prescribe you an antibiotic rinse, chlorhexidine, as an adjunctive therapy. Using it for two weeks will help the gums firm up and heal faster.
• Repair defective restorations. If the gum inflammation and irritation is due to poorly contoured restorations, those will need to be redone.

At home care

• Brush twice a day. You should brush for at least two minutes, once at night and once in the morning. That is the standard recommendation by dentists.
• Floss at night. The best time to floss is before going to bed. Salivary flow slows down significantly while asleep so that is when bacteria can cause the most damage.
• Mouth rinsing. Any type of mouth rinse will suffice in fighting bacteria and plaque. You can use salt water, baking soda, coconut oil, or your trusty old Listerine.

Complications

Failure to treat gingivitis can have severe consequences since it is only the first stage of gum disease. That means when it is left untreated it can progress and advanced to the next stage which is periodontitis.

Unlike gingivitis whose effects are reversible, periodontitis has irreversible consequences. The most prominent side effect is bone loss and once you lose bone around your teeth, it doesn’t grow back. The end result is loose teeth that never tighten back up again.

If this process is allowed to continue, you may end up losing all of your teeth. It would surely be a shame since these teeth weren’t even lost to tooth decay but rather to gum disease!

Prevention

You can reduce your risk for gingivitis by practicing good oral hygiene habits.

• Brush and floss. Probably the most important thing you can do is brushing and flossing! That is more than adequate in reducing the amount of plaque in your mouth.
• Don’t smoke. There is an association with smoking and the severity of gum disease. Try your best to minimize smoking and using other tobacco products.
• Minimize sugar intake. Limit the amount of sugar and carbohydrates in your diet.
• Regular dental check ups. Remember to go see your dentist at least once a year. If you have insurance they do typically pay for it twice a year so you might as well go.

FAQs

Is gingivitis reversible?

The good news is that it is reversible because all of its effects can revert back to normal after proper treatment. The bleeding gums, swelling, and inflammation will go away after shortly after the dental cleaning. In order to maintain it, you must keep up with your oral hygiene.

Can it be cured?

Unfortunately gingivitis cannot be cured permanently. You can manage it by preventing it from becoming over active but you can’t make it go away forever. That is because the bacteria which live in your mouth are what causes it and you can’t permanently eliminate them.

You can periodically cull their population by practicing good oral habits and visiting the dentist regularly. That is enough to keep them under control.