Gingivitis

Picture of gingivitis. Gingivitis is inflammation of the gums caused by bacteria.

Gingivitis is inflammation of the gums (gingiva) surrounding the teeth. Gingivitis affects a significant portion of the population and is the most common form of periodontal diseases (diseases of the tissues surrounding the teeth). Chronic gingivitis may lead to receding gums and can be a precursor of periodontitis.

This inflammation of the gingiva is classified according to severity. It can range from mild to severe gingivitis and more uncommon but serious necrotizing ulcerative gingivitis.

• Inflammation is a complex system by which bacteria-fighting cells of the body are recruited to an area of bacterial infection. Inflammation plays a major role in gingivitis. It is this inflammation of the gums that accounts for most of the symptoms of gingivitis.
• Bacteria can cause inflammation of the gums. Although bacteria are normally found in our bodies and provide protective effects most of the time, bacteria can be harmful. The mouth is an ideal place for bacteria to live. The warm, moist environment and constant food supply are everything bacteria need to thrive. If not for a healthy immune system, bacteria in the mouth would rapidly reproduce out of control, overwhelming the body's defense system.
• An infection begins when the body's immune system is overwhelmed. The gum disease of gingivitis is an infection that occurs when bacteria invade soft tissues and bone adjacent to teeth. The severity of this infection varies from mild to severe and can be an indication of a life-threatening systemic disease.

Gingivitis is a bacterial infection of the gums. The exact reason why gingivitis develops has not been proven, but several theories exist.

• For gingivitis to develop, plaque must accumulate in the areas between the teeth. This plaque contains large numbers of bacteria thought to be responsible for gingivitis. But it is not simply plaque that causes gingivitis. Almost everyone has plaque on their teeth, but gingivitis is far less common.
• In certain instances, an individual may have an underlying illness or condition that renders their immune system susceptible to gingivitis. For example, people with diabetes and other immune system diseases (such as HIV) have a weaker ability to fight bacteria invading the gums. People who smoke, chew tobacco, or have a substance abuse problem are also predisposed to develop gingivitis.
• Overconsumption of alcohol can lead to gingivitis.
• Sometimes hormonal changes in the body during pregnancy, puberty, and steroid therapy leave the gums vulnerable to bacterial infection.
• Local factors, such as crowded teeth and poor fitting or altered tooth anatomy due to dental work increase an individual's susceptibility to gingivitis.
• A number of medications used for seizures, high blood pressure, and organ transplants have been shown to cause an enlargement of the gingiva.

• The presence of dental plaque, a sticky substance on the teeth, will inevitably cause gingivitis.
• Swelling, redness, pain, and bleeding of the gums are signs of gingivitis. Swelling of the gums is referred to as gingival hyperplasia.
• Receding gums are a sign of gingivitis that may be advancing into periodontal disease.
• Loose teeth or tooth loss in the presence of gum inflammation is a sign of gingivitis and periodontal disease.
• Halitosis (bad breath), in which the breath begins to take on a foul odor, may be present in more severe forms of gingivitis.

For simple gingivitis, work with a dentist. A concerted effort involving good home dental hygiene, including regular and correct brushing and flossing, and regular dental visits should be all that is required to treat and prevent gingivitis. Gingivitis can usually be managed at home with good dental hygiene.

If gingivitis continues despite the effort to prevent it, contact a doctor to investigate the possibility of an underlying illness. If there are other conditions that seem to be coinciding with the signs and symptoms of gingivitis, seek medical attention. For example, chronic gingivitis and periodontitis are felt by medical scientists to be risk factors for the development of rheumatoid arthritis.

One complication of gingivitis may be the presence of ulcers on the gums -- if rampant, this could be a sign of acute necrotizing ulcerative gingivitis (ANUG) and will require medical diagnosis and treatment.

Another complication is a so-called desquamative condition of the gums, in which ulcers, blistering, and sloughing affect the gums. This can be a sign of lichen planus, mucous membrane pemphigoid (MMP), and pemphigus vulgaris. These conditions often require a consultation and usually a biopsy from a periodontist or oral pathologist to diagnose and treat.

Early and acute gingivitis is treated with thorough dental cleanings performed by registered dental hygienists. This in conjunction with regular monitoring, and diagnosis by a licensed dentist is usually all that is needed.

For cases in which the gingivitis has become chronic, aggressive, or has been diagnosed as acute necrotizing ulcerative gingivitis (ANUG) or juvenile gingivitis, a periodontist may be needed to help treat and reverse the disease.

Gingivitis is a clinical diagnosis. This means that the physician or dentist can arrive at the diagnosis by listening to the person's medical and dental history and performing an oral exam. Blood work, X-rays, and tissue samples may be indicated for people not responding to initial therapy. The person should, however, be evaluated for underlying disease that may cause gingivitis.

Removing the source of the infection is primarily how simple gingivitis is treated. Home treatment is key. Ultimately, these home remedies can lead to a cure for gingivitis.

• By tooth brushing regularly with a soft-bristled or electric toothbrush and fluoride toothpaste approved by dentists, plaque buildup can be kept to a minimum. The presence of triclosan combined with fluoride has proven to significantly reduce the formation of plaque on the teeth.
• Flossing once per day is another means of removing plaque in between teeth and other areas hard to reach.
• Regular checkups with a dentist are also important. A dentist is able to remove plaque and calculus (hardened plaque) that is too dense to be removed by a toothbrush or dental floss.
• Once a dentist removes plaque, regular brushing and flossing will minimize plaque formation. Even with good dental hygiene, plaque will begin to accumulate again.
• Correct dental defects, such as over contoured or poorly fitting fillings, crowns, and other restorations.
• Avoid smoking.
• Limit sugar consumption.
• Drink plenty of water.
• Severe gingivitis may require antibiotics like azithromycin and consultation with a physician. Antibiotics are medications used to help the body's immune system fight bacterial infection and have been shown to reduce plaque. By reducing plaque, bacteria can be kept to a level manageable by the human immune system. Taking antibiotics is not without risks and should only be done after consultation with a dentist or doctor.
• Some studies have shown brushing with a solution made of baking soda and peroxide will reduce the bacteria that cause gingivitis.
• Mouthwashes that contain essential oils have shown the ability to reduce plaque formation and treat gingivitis when used in conjunction with professional cleanings and daily brushing. Specific ingredients include thymol, eucalyptol, methyl salicylate, and menthol.
• Oil pulling is the practice of swishing fractionated coconut oil for 20-30 minutes, then spitting it out and brushing your teeth. This will reduce inflammation and bacterial contamination of your gums.
• Some have used the main ingredient in aspirin, salicylic acid, to fight gum disease; but this should be avoided as it often can lead to burns on the gums.

Most cases of simple gingivitis can be managed and reversed simply with good oral hygiene and regular dental appointments. With severe gingivitis, gum recession can require surgical repair.

It is important to understand that gingivitis is a product of a person's own local and systemic health and hygiene and is not a contagious condition. Therefore, controlling the risk factors individually will lead to a favorable prognosis in reversing and curing the disease.