Gingivitis (Gum Disease) Overview

Gingivitis is usually caused by an overgrowth of dental plaque. In addition to improper dental hygiene, there can be many contributing factors, such as:

• certain medications, such as phenytoin, cyclosporine, calcium channel blockers, and oral or injectable birth control (these medications can cause gingivitis or make it worse because they can lead to an overgrowth of gum tissue and make plaque hard to remove)
• severe deficiencies of vitamin C (this is rare in the United States)
• hormonal changes, including during pregnancy and menopause
• leukemia
• heavy metals like nickel, which can be found in some jewelry
• exposure to bismuth, which can be found in some makeup

There are some types of gingivitis-causing gum infections that are not related to plaque overgrowth. These include:

• certain viral or fungal infections, such as thrush
• an impacted tooth, or tooth that doesn’t fully emerge (if this happens, the flap of gum over the tooth can trap debris and cause gingivitis)

Your gums actually attach to the teeth at a lower point than the gum edges we see. This forms a small space called a sulcus. Food and plaque can get trapped in this space and cause a gum infection or gingivitis.

Plaque is a thin film of bacteria. It constantly forms on the surface of your teeth. As plaque advances, it hardens and becomes tartar. You can develop a gum infection when plaque extends below the gum line.

If left unchecked, gingivitis can cause the gums to separate from the teeth. This can cause:

• injury to the soft tissue and bone supporting the teeth
• the tooth to become loose and unstable
• the loss of the tooth, if infection progresses

The following are risk factors for gingivitis and periodontitis:

• smoking or chewing tobacco
• diabetes
• certain medications, such as:
  • oral contraceptives
  • steroids
  • anticonvulsants
  • calcium channel blockers
  • chemotherapy
• crooked teeth
• improper fit on dental appliances
• broken fillings
• pregnancy
• genetic factors
• suppressed immunity, such as with HIV

Many people aren’t aware that they have gum disease. It’s possible to have gingivitis without any symptoms. However, the following can be symptoms of gum disease:

• gums that are red, tender, or swollen
• gums that bleed when you brush or floss your teeth
• gums that have pulled away from your teeth
• loose teeth
• a change in how your teeth fit together when you bite (malocclusion)
• pus between your teeth and gums
• pain when chewing
• sensitive teeth
• partial dentures that no longer fit
• foul-smelling breath that doesn’t go away after you brush your teeth

It’s important to contact a dentist if you think you might have gum disease because it can still be reversed at early stages. Contact a dentist if you have any symptoms of gum disease. Early signs are usually gums that are red, swollen, and bleeding easily.

If you need help finding a dentist, then check out our FindCare tool here.

During a dental exam, your gums will be probed with a small ruler.

• This probing is a way to check for inflammation.
• It measures any pockets around your teeth. A typical depth is 1 to 3 millimeters.
• Your dentist may also order X-rays to check for bone loss.

Speak with your dentist about risk factors for gum disease, as well as your symptoms. This can help diagnose gingivitis. If gingivitis is present, you may be referred to a periodontist. A periodontist is a dentist who specializes in the treatment of gum diseases.

You must practice good oral hygiene to treat gingivitis. You should also cut back on any smoking if you smoke and manage your diabetes if you live with this condition. Quitting smoking may be difficult, but a doctor can help build a cessation plan that works for you.

Other treatments include:

• deep cleaning your teeth
• antibiotic medications
• surgery

Cleaning teeth

There are several techniques that can be used to deep clean your teeth without surgery. They all remove plaque and tartar to prevent gum irritation:

• Scaling. Teeth scaling removes tartar from above and below the gum line.
• Root planing. This smooths rough spots and removes plaque and tartar from the root surface.
• Lasers. This treatment may remove tartar with less pain and bleeding than scaling and root planing.

Medications

A number of medications can be used to treat gum disease:

• Antiseptic mouthwash containing chlorhexidine can be used to disinfect your mouth.
• Timed-release antiseptic chips containing chlorhexidine can be inserted into pockets after root planing.
• Antibiotic microspheres made with minocycline can be inserted into pockets after scaling and planing.
• Oral antibiotics can be used to treat persistent areas of gum inflammation.
• Doxycycline, an antibiotic, can help keep enzymes from causing tooth damage.

Surgery

If your gingivitis is severe, especially if it’s caused any gum or bone tissue loss, you may need surgery. Types of gum surgery, which is performed by a periodontist, include:

• Flap surgery. Flap surgery is a procedure where the gums are lifted back while plaque and tartar is removed from deeper pockets. The gums are then sutured in place to fit snugly around the tooth.
• Bone and tissue grafts. Grafting can be used when your teeth and jaw are too damaged to heal.
  • Gum graft surgery uses tissue from the roof of your mouth to cover the exposed tooth root. This helps prevent additional gum and bone loss.
  • For a bone graft, your doctor will start with a procedure similar to flap surgery, but they’ll put in a bone graft to encourage your body to regenerate any lost jaw bone.
• Dental crown lengthening. Some people with gingivitis may have excess gum tissue. If this is the case, a periodontist can reshape your gum and bone tissue to expose more of your teeth. This may also be necessary before certain cosmetic or restorative procedures on your teeth.

Proper and consistent oral hygiene can prevent gum disease. This includes:

• visiting the dentist regularly
• brushing your teeth twice daily with fluoride toothpaste
• flossing your teeth every day

Eating a balanced diet is also important to achieving and maintaining dental health.

The Centers for Disease Control and Prevention (CDC) and the National Institute of Dental and Craniofacial Research report that periodontal disease is associated with an increased risk for:

• diabetes
• heart disease
• stroke
• lung disease

It also increases the risk of a person giving birth to a premature or low birth weight infant.

Although gum disease is associated with these health conditions, it hasn’t been shown to cause them. More research is needed to determine the specifics of this association.