Gingivitis: Causes, Symptoms, Diagnosis, Complications, Prevention & Treatment.


  1. Introduction to Gingivitis
  2. Causes of Gingivitis
  3. Symptoms of Gingivitis
  4. Prevention of Gingivitis
  5. Diagnosis of Gingivitis
  6. Gingivitis Treatment
  7. Gingivitis Complications

Introduction to Gingivitis:

Gingivitis is the inflammation of the gums around the teeth. Gingivitis may be caused by a build up of plaque and tartar caused by improper cleaning of teeth or by injury to the gums from excessive brushing. Gingivitis is generally reversible. Brushing teeth thoroughly but gently and flossing are the most effective ways to prevent gingivitis.

Causes of Gingivitis:

Gingivitis is usually caused by plaque, bacteria and food particles that accumulate in the spaces between the gums and the teeth. These accumulations may be tiny, even microscopic, but the bacteria in them produce foreign chemicals and toxins that cause inflammation of the gums around the teeth. This inflammation can, over the years, cause loss of bone around teeth otherwise known as periodontitis. Since the bone in the jaws holds the teeth into the jaws, the loss of bone can cause teeth over the years to become loose and eventually to fall out. Regular cleanings below the gum line, best accomplished professionally by a dentist, disrupt these plaque and bacteria and help prevent inflammation. Once cleaned, it takes 3-4 months for the bacteria and plaque to grow back and once again restart the inflammation process. Ideally, then, scientific studies show that all people should have their gums cleaned by a dentist every 3-4 months. However, most dentists recommend cleanings every 6 months, because this has been the standard advice for decades, and because the benefits of regular tooth cleanings are too subtle for many patients to notice. If the inflammation in the gums becomes especially well-developed, it can break through the gums and allow tiny amounts of bacteria and bacterial toxins to enter the bloodstream. The patient may not be able to notice this, but studies suggest this can result in a generalized increase in inflammation in the body and possible heart problems long-term.

Sometimes, the inflammation of the gingiva can suddenly amplify, such as to cause a disease called Acute Necrotizing Ulcerative Gingitivitis, otherwise known as "trenchmouth." This results in the breath being extremely bad-smelling, and the gums feeling considerable pain. Fortunately, this can be cured with a 1-week dose of Metronidazole antibiotic, followed by a deep cleaning of the gums by a dentist.

When the teeth are not cleaned properly, dental plaque accumulates, transforming into a hard material called tartar and irritating the gums, and bacteria and toxins may cause the gums to become red and swollen. Alternatively, excessive injury to the gums caused by very vigorous brushing may lead to inflammation and infection. Pregnancy, uncontrolled diabetes mellitus and the onset of puberty increase the risk of gingivitis, due to hormonal changes that may increase the susceptibility of the gums or alter the composition of the dentogingival microflora. The risk of gingivitis is increased by dental calculus, misaligned teeth, the rough edges of fillings, and ill fitting or unclean dentures, bridges, and crowns. The drug phenytoin, birth control pills, and ingestion of heavy metals such as lead and bismuth may also cause gingivitis. The sudden onset of gingivitis in a normal healthy person should alert to the possibility of an underlying viral aetiology.

Symptoms of Gingivitis:

The symptoms of gingivitis are:
  • Swollen gums
  • Mouth sores
  • Bright red/purple gums
  • Shiny gums
  • Gums that are painless except when touched
  • Gums that bleed easily
  • Gums that itch
  • Receding gumline

Prevention of Gingivitis:

Gingivitis may be prevented by maintaining proper oral hygiene. That includes daily brushing with anti-tartar fluoride toothpaste and flossing with dental floss or any other flossing device.

Gingivitis Diagnosis:

A dentist should be seen as soon as signs of gingivitis appear. A dentist will check for the symptoms of gingivitis and examine how much plaque is in the oral cavity. A dentist may also test for periodontitis using X-rays or gingival probing.

Gingivitis Complications:

  • Recurrence of gingivitis<./li>
  • Periodontitis.
  • Infection or abscess of the gingiva or the jaw bones.
  • Trench mouth: bacterial infection and ulceration of the gums.

Gingivitis Treatment

A dentist or dental hygienist will perform a thorough cleaning of the teeth and gums. Following that, persistent oral hygiene is necessary. The removal of plaque is usually not painful, and the inflammation of the gums should be gone between one and two weeks. Oral hygiene is necessary to prevent the recurrence of gingivitis. Anti-bacterial mouthwash reduce the swelling Local mouth gels or solutions, which are usually antiseptic and anaesthetic, can also help.

1. Antibiotics

Antibiotics are used to eradicate the bacterial infection. In the future, antibiotics also may be used to treat simple chronic gingivitis, but there is no current evidence to justify this practice. The treatment of gingivitis can be warranted if dental surgery is planned.

  • Penicillin VK (Brand name: Veetids): Penicillin VK is an antibiotic
  • Erythromycin (Brand names: EES, Ery-Tab, Erythrocin): Erythromycin is an lternative DOC for patients allergic to penicillin.
  • Minocycline microspheres (Brand name: Arestin): Minocycline microspheres may be used as an adjunct to scaling and root planing procedures to reduce pocket depth in patients with adult periodontitis. Minocycline microspheres may be used as part of a periodontal maintenance program that includes good oral hygiene,scaling and root planing.
  • Doxycycline (Brand name: Periostat): Doxycycline inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. However, some studies have shown that doxycycline reduces elevated collagenase activity in gingival crevicular fluid of patients with adult periodontitis. The clinical significance of these findings is not known.

2. Antiseptics

Antiseptics decrease bacterial counts in oral flora, speeding up the resolution of gingivitis when combined with brushing and flossing.

  • Chlorhexidine 0.12% (oral rinses) (Brand name: PerioGard): PerioGard has bactericidal activity.
  • Saline (oral rinses)
  • Hydrogen peroxide (oral rinses)

3. Analgesics

A strong analgesic along with topical anesthetics and NSAIDs because pain control is very important in allowing the patient to eat and carry out toothbrushing, flossing, and other oral hygiene maneuvers necessary to eradicate the disease. NSAIDs also help to decrease pain. Although effects of NSAIDs in the treatment of pain tend to be patient-specific, ibuprofen usually is the DOC for initial therapy.

  • Acetaminophen with codeine (Tylenol #3): Narcotic analgesic well tolerated by most patients; it may induce severe nausea and vomiting in patients particularly sensitive to the drug.
  • Acetaminophen with codeine (Tylenol #4): Same as Tylenol #3, but with more codeine for stronger effect.
  • Ibuprofen (Ibuprin, Advil, Motrin): Used for pain relief and to decrease gingival inflammation. Use with care in patients with a history of asthma or peptic ulcer disease.

4. Topical anesthetics

Topical anesthetics are helpful in providing pain control, which is very important in allowing the patient to carry out toothbrushing, flossing, and other oral hygiene maneuvers.

  • Lidocaine viscous 2% (Dilocaine) -- An adjunctive therapy for pain control that decreases the permeability to sodium ions in neuronal membranes. This results in inhibition of depolarization, blocking the transmission of nerve impulses.
  • Topical Xylocaine