What is Gingivitis (Inflammation of the Gums)?
Gingivitis is a condition where the gums become inflamed. Most times, it’s caused by a bacterial infection. Unlike a more serious gum disease called periodontitis, gingivitis doesn’t result in loss of tissue attachment to the tooth or gum recession. It only affects the soft parts of the gums.
Of all diseases related to the gums, gingivitis is the most common. There are different types of gingivitis, and these are defined based on how they look, how long they’ve been present, how severe they are, and what causes them. Still, the most common type is the chronic form caused by dental plaque.
In terms of symptoms, the gums swell, turn red, feel tender or sensitive, appear shiny, and bleed easily, such as when gently brushed or probed. Since gingivitis rarely causes spontaneous bleeding or pain, many people don’t realize they have it and don’t seek treatment.
What Causes Gingivitis (Inflammation of the Gums)?
Gingivitis is caused by microbial plaque, a kind of sticky film, that builds up on your teeth, particularly near your gums. This plaque is home to different types of bacteria such as Streptococcus, Fusobacterium, and Actinomyces among others. Some factors might make the tissue in your mouth more prone to this bacterial attack, leading to gingivitis.
There are different types of gingivitis depending on what causes it:
1. Plaque Induced Gingivitis: This is the most common type, and it is caused by poor oral hygiene. If plaque is not regularly cleaned off your teeth, it can harden and become calculus, causing inflammation in your gums. Certain factors like crowded teeth, poorly fitted dental work, or even the eruption of new teeth in children can make it harder to keep plaque at bay.
2. Nutritional Gingivitis: This happens when you don’t consume enough vitamin C. Diets with a lot of refined carbohydrates and an imbalance of certain types of fatty acids might increase inflammation.
3. Hormonal Gingivitis: This is more likely to occur during times of hormonal changes like pregnancy or puberty, where even small amounts of plaque can cause a significant gingival response due to increased hormone levels and changes in blood vessels.
4. Drug-Induced Gingivitis: Some medications can cause gingivitis as a side effect, including those used for epilepsy, high blood pressure, and contraception among others. This is because these drugs can cause fibroblasts, a type of cell, to overproduce, leading to a build-up of proteins such as collagen in the mouth which can cause gingivitis.
On top of these, factors like smoking, systemic health conditions, genetic susceptibilities, and local issues like a dry mouth or crowded teeth can also contribute to the development of gingivitis.
Risk Factors and Frequency for Gingivitis (Inflammation of the Gums)
Gingivitis is the most common gum disease and tends to affect more males than females, as females generally take better care of their oral health. Another factor is economic status; people with lower income are more likely to suffer from gingivitis because they might not have access to good healthcare or maintain high standards of oral hygiene. Pregnant women are also more prone to gingivitis and can even experience more severe forms of the disease.
- Several types of gingivitis exist, including plaque-induced, hormonal, acute ulcerative necrotizing, drug-induced, and spontaneously presenting hyperplastic gingivitis.
- Plaque-induced gingivitis is the most common form, accounting for more cases than all other types put together.
Signs and Symptoms of Gingivitis (Inflammation of the Gums)
Healthy gums should look pink or, in dark-skinned individuals, they might be pigmented. Gums should be firm, and not show any redness, swelling, or bleeding when a dental probe is gently passed along the gum line. In a healthy mouth, when using a periodontal probe, the crevice of the gums should show less than 3mm and there should be no loss of bone visible in any x-rays.
In some cases, gingivitis, which is a disease where the gums become inflamed, may progress without any noticeable symptoms leaving patients unaware. Sometimes symptoms do surface, and may include reports from patients of gum bleeding during brushing, flossing, or eating of particularly hard food. Bad breath, or halitosis, may also be present even after performing oral hygiene procedures. Physical check on the oral cavity may show inflamed and tender gums that bleed on gentle probing. Healthy gums have a knife-edge look and a speckled appearance which may be replaced by a more rounded and shiny aspect in the case of gingivitis. There are often significant deposits of plaque and calculus visible.
In chronic gingivitis, the gum tissue size may increase due to swelling or hyperplasia, revealing probing depths of more than 3mm. Though this swelling can occur, no attachment loss has taken place. This condition creates what are known as false pockets.
The swelling of the gums can fall into four categories:
- Grade 0: No noticeable signs of gum swelling
- Grade I: Swelling is limited to the interdental papilla region only
- Grade II: Swelling is present in both the interdental papilla and the marginal gingiva
- Grade III: Swelling covering three-fourths or more of the crown structure
The Gingival Index, or GI, is used to gauge the health of the gum tissue, differentiating the severity of the lesion, and the location of the alteration in the four areas that form the perimeter of the marginal gingiva. Scores from 0 to 3 are given to each area of the tooth. Adding those scores together and dividing them by four gives the GI score for that tooth. The overall GI score for a person is figured out by adding all tooth indices and dividing this by the number of teeth examined.
The gingival index scores criteria:
- 0: Normal gums
- 1: Mild inflammation – a slight color change and slight swelling. No bleeding on probing.
- 2: Moderate inflammation – redness, swelling, and a smooth look. Bleeding triggered by probing.
- 3: Severe inflammation – prominent redness and swelling. Ulceration. May bleed spontaneously.
In 2017, an international workshop created a classification for gingival diseases:
- Gingivitis – dental biofilm-induced:
- Linked purely with dental biofilm
- Can be mediated by systemic or local risk factors
- Drug-influenced gingival enlargement
- Gingival diseases that are not dental biofilm induced:
- Genetic or developmental disorders
- Specific infections
- Inflammatory and immune conditions
- Reactive processes
- Cancer (neoplasms)
- Endocrine, nutritional, and metabolic diseases
- Physical injuries (traumatic lesions)
- Gum pigmentation
Testing for Gingivitis (Inflammation of the Gums)
Gingivitis is a disease that affects the soft tissues in your mouth, so typically, you won’t need to have an x-ray. However, in some cases, your dentist might decide to do an x-ray to tell the difference between gingivitis and a similar condition called periodontitis. Usually, you won’t need to have any lab tests done either.
Treatment Options for Gingivitis (Inflammation of the Gums)
The main goal of treating gingivitis, or gum inflammation, is to lessen the inflammation. This is usually done by using various tools to remove plaque, a sticky film full of bacteria, from the teeth. If caught early on, gingivitis can be managed relatively easily if the person sticks to a regimen of proper oral hygiene. This includes regular brushing with the correct technique and cleanings between the teeth using dental floss or interdental brushes. Depending on how severe the condition is, a healthcare professional might also perform a procedure known as scaling and root planing to remove plaque and tartar.
If the gum overgrowth is due to certain medications, the doctor might switch the prescribed drug to improve the treatment results. In cases where the gingivitis is linked to nutritional deficiency, supplements can be recommended. Mouthwashes containing the antiseptic chlorhexidine can also be prescribed alongside plaque removal procedures. Studies have suggested that using chlorhexidine mouthwash in conjunction with regular brushing and interdental cleaning can significantly reduce the plaque formation. The concentration of chlorhexidine in the mouthwash doesn’t seem to affect its efficacy.
Research has also spotlighted the impact of certain medicinal or herbal plants on managing gingivitis due to their anti-inflammatory properties. These plants, such as pomegranate, tea, and chamomile contain flavonoids and tannins, which are powerful anti-inflammatory and astringent compounds. These ingredients can help manage gum bleeding and inflammation. Some studies have found that the treatment effectiveness can be boosted when these herbal remedies are used alongside traditional plaque removal procedures like scaling.
What else can Gingivitis (Inflammation of the Gums) be?
Gingivitis and periodontitis are two different conditions that affect your gums. One way to tell them apart is that in periodontitis, the attachment connecting the tooth and the gum weakens, which becomes evident during a dental examination. In addition, there are differences in the tissue and bone structures surrounding the teeth, which can be identified with medical imaging and microscopic examination of the tissue.
What to expect with Gingivitis (Inflammation of the Gums)
Gingivitis is a condition that can be fully treated if identified early. In such cases, the affected tissues can go back to their normal state once the build-up of bacteria, known as dental biofilm, has been removed. However, if gingivitis worsens and turns into periodontitis, it can lead to the loss of tissue attachment and destruction of bone in your mouth, which could eventually lead to losing your teeth.
Possible Complications When Diagnosed with Gingivitis (Inflammation of the Gums)
The main issues that can arise from ongoing gingivitis include an increased inflammation that moves to the surrounding tissue and bone beneath, causing a condition called periodontitis. The most severe outcome of this progression is the loss of a tooth. While gingivitis can lead to periodontitis, it’s not always the case that gingivitis will turn into periodontitis.
Preventing Gingivitis (Inflammation of the Gums)
Patients should be instructed on the crucial role of taking care of their teeth and mouth. Good oral care helps avoid the buildup of plaque and prevents gum diseases like gingivitis. This involves teaching them the right way to brush their teeth, which differs from person to person, and reminding them to brush frequently. It’s also important to show patients how to clean between their teeth properly. Regular visits to the dentist are also key to maintaining oral health. Additionally, it may be recommended to use mouthwash for extra protection.
