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Causes, incidence, and risk factors
Gingivitis is the first form of periodontal disease. Periodontal disease involves inflammation and/or infection that results in destruction of the tissues that support the teeth, including the gingiva (gums), the periodontal ligaments, and eventually the tooth sockets (alveolar bone).

Gingivitis is caused by the long-term effects of plaque deposits. Plaque is the sticky material that develops on the exposed portions of the teeth, consisting of material such as bacteria, mucus, and food debris. It is a major cause of dental caries. Unremoved plaque mineralizes into a hard deposit called calculus (tartar) that becomes trapped at the base of the tooth. Plaque and calculus cause mechanical irritation and inflammation of the gingiva. Bacteria, and the toxins produced by the bacteria, cause the gums to become infected, swollen, and tender.

Injury or trauma to the gums from any cause, including overly vigorous brushing or flossing of the teeth, can also cause gingivitis. The risks for development of gingivitis include uncontrolled diabetes, pregnancy (because of hormonal changes that increase the sensitivity of the gingiva), general (systemic) illness, and poor dental hygiene. Misaligned teeth, rough edges of fillings, and ill fitting or unclean mouth appliances (such as orthodontic appliances, dentures, bridges, and crowns) can irritate the gums and increase the risk of gingivitis. Medications such as phenytoin and birth control pills, and ingestion of heavy metals such as lead and bismuth are also associated with gingivitis.

Many people experience gingivitis to a varying degree. It usually develops during puberty or early adulthood due to hormonal changes and may persist or recur frequently depending on the oral hygiene status of the patient.

Prevention
Good oral hygiene is the best prevention against gingivitis because it removes the plaque that causes the disorder. The teeth should be brushed at least twice daily and flossed gently at least once per day. For people who are prone to gingivitis, brushing and flossing may be recommended after every meal and at bedtime. Consult the dentist or dental hygienist for instructions on proper brushing and flossing techniques.

Special appliances or tools may be recommended by the dentist for use by people who are particularly prone to plaque deposits. Their use supplements, but does not replace, thorough brushing and flossing. Appliances and tools may include special toothpicks, toothbrushes, water irrigation, or other devices. Electric toothbrushes were initally recommended for persons who have problems with strength or dexterity of their hands, but are now recommended to many patients to improve their oral hygiene.

Antiplaque or antitartar toothpastes or mouth rinses may be recommended by the dentist or dental hygienist.

Regular professional tooth cleaning is important to remove plaque that may develop even with careful brushing and flossing. Many dentists recommend having the teeth professionally cleaned at least every 6 months.

Symptoms

• mouth sores
• swollen gums
• the gums appear bright red or red-purple
• the gums appear shiny
• the gums bleed easily, blood appears on toothbrush even with gentle brushing of the teeth
• the gums are tender when touched, but otherwise painless

Signs and tests
Consult the dentist if signs of gingivitis are present. Examination of the mouth and teeth shows soft, swollen, red-purple gingiva. Deposits of plaque and calculus may be visible at the base of the teeth. The gums are usually painless or mildly tender.

No further testing is usually necessary, although dental X-rays and dental gingival probing (measuring the amount of bone) may be performed to determine whether periodontitis (spread of inflammation to the supporting structures of the teeth) has developed.

Treatment
The goal of treatment is reduction of gingival inflammation.

The teeth are cleaned thoroughly by the dentist or dental hygienist. This may involve the use of various instruments or devices to loosen and remove deposits from the teeth (scaling).

Meticulous oral hygiene is necessary after professional tooth cleaning. The dentist or hygienist will demonstrate brushing and flossing techniques. Professional tooth cleaning in addition to brushing and flossing may be recommended twice per year or more frequently for severe cases. Antibacterial mouth rinses or other aids may be recommended in addition to frequent, careful, tooth brushing and flossing.

Repair or replacement of dental and/or orthodontic appliances or misaligned teeth may be recommended.

Systemic illness or other conditions should be treated.

Prognosis
Removal of plaque from inflamed gums may be uncomfortable. Bleeding and tenderness of the gums should reduce within 1 or 2 weeks after professional cleaning and careful oral hygiene. Warm salt water or antibacterial rinses can aid in the reduction of the puffiness. Over the counter anti inflmmatory medicatinos will ease any discomfort which may have developed as a result of a rigourous cleaning. Healthy gums are pink and firm in appearance. Strict oral hygiene must be maintained lifelong or gingivitis will recur.

Complications

• a recurrence of gingivitis
• periodontitis
• an infection or abscess of the gingiva or the jaw bones
• trench mouth

Calling your health care provider
Call your dentist if symptoms of gingivitis are present, especially if you have not had a routine cleaning and examination in the last 6 months.

Call your health care provider if the dentist recommends medical treatment of underlying conditions that contribute to the development of gingivitis.

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