Gingivitis is a disease that causes the gum tissue to become inflamed. With proper treatment, which primarily focuses on oral hygiene, is usually reversible, as it does not destroy any of the tissues of the periodontium. Most commonly, it is caused by bacterial plaque that builds up on the surfaces of the teeth. Gingivitis is the most common type of periodontal disease, and, if not treated, will usually progress to periodontitis. Periodontitis is characterized by the destruction of tissue and the resorption of bone and is therefore non-reversible, though it is treatable. If not treated effectively, periodontitis can eventually lead to loss of the teeth.
The symptoms of gingivitis are similar to the signs of any inflammation and include swelling and discoloration; gums that are tender or painful when stimulated; bleeding, either unprompted or after brushing or flossing; and bad breath. In some patients, the gum tissue may also change texture, losing the stippling that can characterize healthy gums and becoming shiny and visibly taut. Though gingivitis is reversible, it can recur if maintenance is insufficient, and it can lead to periodontitis if not adequately treated and maintained. Gingivitis may also be complicated by infection or abscess, ulceration, and swollen lymph nodes, and it is associated with premature birth and low birth weights. More recently, it has been suggested that the bacteria that cause gingivitis are connected to Alzheimer’s disease, though more evidence is needed to support this idea or suggest any causal link.
Plaque-induced gingivitis is caused by a host response between the body’s immune system and bacterial plaque. When plaque accumulates on the teeth and in the small gaps between the teeth, or on and around dental restorations and orthodontic devices, and is not sufficiently removed through brushing and flossing, the bacteria in this maturing plaque becomes increasingly complex, producing toxins and enzymes that prompt an inflammatory response in the tissue of the gums. The primary risk factor for gingivitis is poor oral hygiene, though overly aggressive oral hygiene may also lead to inflammation. Other risk factors include age, lack of access to clinical care, osteoporosis, mouth breathing, medications that cause dry mouth, cigarette smoking, stress, compromised mental health, certain pre-existing systemic conditions and diseases, and genetic factors.
Because the symptoms of gingivitis may be painless at first, periodic dental checkups are instrumental in providing early diagnoses. During these checkups, a dental hygienist or dentist will examine the oral cavity visually and with x-rays, as well as probing the gingiva with clinical tools to assess the health of the gums. They will also review the patient’s medical and dental history. Treatment for gingivitis focuses on the removal of plaque and the reduction of future plaque accumulation. The most commonly used methods are dental deep cleanings, including scaling, root planing, and curettage, all of which must be executed by a dental health professional, and effective home oral hygiene practices that may include chlorhexidine or hydrogen peroxide mouth rinses. In some cases, a topical antibiotic rinse may also be recommended. If gingivitis does not respond to these traditional therapies, the patient may be referred to a periodontist, a dental health specialist who focuses on pathologies of the periodontium, for additional treatment.