Gingivitis - Magrabi Hospitals

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Gingivitis Definition

It is a common gum disease (Gum: is the tissue surrounding the base of the teeth). Healthy gums should be pink, pale and doesn’t bleed.

Gingivitis causes irritation, inflammation, erythema, swelling of the gingiva. Unfortunately, gingivitis is not a mild disease, and if left unattended it may cause periodontitis and eventually tooth loss.

One of the most common and important causes of gingivitis is poor oral hygiene.

If you brush twice a day, floss daily and visit your dentist regularly then you can prevent, stop and minimize gingivitis.

Symptoms of gingivitis

Our normal healthy gums are usually pinkish or pale reddish and fit properly around the base of our teeth.

If you suffer from gingivitis you may notice any of some of the following symptoms

  • Swelling of the gums.
  • Gums darken in color into dark pink or dusky red.
  • When you brush or floss, your gum bleeds easy.
  • Foul breath.
  • Receding gums.
  • Painful gums.

When to book an appointment with your dentist?

If you suffer any of these symptoms its best to schedule an appointment with your dentist as soon as possible, because the sooner you address the problem, the easier it gets to prevent its complications.

Causes of gingivitis

Poor oral hygiene is one of the most common causes of gingivitis.

It forms plaque around the teeth, then causes inflammation of the adjacent gum tissue.

But what is plaque? And how does it lead to gingivitis?

Plaque: is an invisible film that is sticky and made mostly of bacteria. It happens when starchy and sugary food interacts with the bacteria that is naturally found in our mouth. By daily brushing and flossing, plaque is removed but unfortunately, it reform again quickly!

But what if you do not floss daily? Then plaque will turn into tartar! Which means that the plaque hardened under the gum line turning it into calculus (tartar) which makes plaque layer harder to remove!

This layer then offers a protective film for the bacteria, allowing it to turn into harmful bacteria.

This harmful bacteria will cause irritation of the gum line. At this point, dental care by professionals is mandatory to clean up and remove the tartar.

After this point, if no care is given to your teeth, gingivitis will occur! Because the longer tartar & plaque stay on your gums, the more the irritation of the gingiva (as explained before: the part of the gum that surrounds the base of the teeth). Then the gums get swollen and start to bleed when brushing or when eating solid food.

Later, tooth decay and eventually teeth loss will occur if not treated properly.

Risk factors

Gingivitis is a very common symptom, it may be due to habitual or pathological diseases:

  • Poor hygiene of the mouth (irregular brushing and flossing).
  • Ageing.
  • Dry mouth.
  • Insufficient nutrition especially vitamin C.
  • Ill-fitting dentures.

Pathological diseases include:

  • Any disease that causes a decline in immunity like HIV and cancer treatment.
  • Intake of certain drugs such as anti-epileptic drugs, anti-angina, anti-hypertensive drugs.
  • Any hormonal level change such as in pregnancy. Menstruation or intake of oral contraceptive pills.


Complications due to gingivitis may happen due to inflammation of oral gum per se, or as a result of the original disease.

When gingivitis goes untreated, it progresses to the underlying tissue causing periodontitis. Untreated periodontitis may lead to tooth loss.

Some scientific papers have found a solid correlation between chronic gingivitis and other systemic diseases like: upper respiratory tract infection, diabetes mellitus, heart diseases, strokes and rheumatoid diseases.

Some research implicates that the bacteria causing the periodontitis may go into your bloodstream through the inflamed gum tissue then reach other organs like your heart, lungs and others.

A disease known as necrotizing ulcerative gingivitis (Trench mouth), is a very severe form of gingivitis! Its symptoms include pain, infection, bleeding gums and ulcers.

It is a rare disease in developed countries, but still common in under-developed countries that still live in inhumane conditions.

Prevention of Gingivitis

Proper oral hygiene

Brushing your teeth correctly for at least 2-3 minutes twice per day (once in the morning, the other before sleeping), and after every meal is the first line against gingivitis!

Flossing once daily and after eating solid food allows the proper cleaning of food debris and bacteria.

Visiting your dentist regularly

Visiting your dentist on regular basis is not a luxury! It is mandatory! Because cleaning your teeth professionally every 6-12 months can eliminate many risk factors that may lead to gingivitis! Decreasing the risk of periodontitis!

If you have any risk factor ( such as dry mouth, smoking, underlying disease), visiting your dental hygienist more often is important to monitor the progress of the disease and identify any complication as early as possible!

Healthier lifestyle

Some healthy lifestyle changes like eating healthier and avoiding sugary food, controlling your blood sugar are all good practices to improve your gum health and avoid its complications!

Diagnosis of gingivitis

Dentists easily diagnose gingivitis through your dental and medical history!

But diagnosing the extent of the disease requires the following:

Examining the teeth, gums, inner cheeks and tongue for plaque and inflammation.

Pocket depth is another indication of the extent of the disease:

It is the groove between the gum and the teeth, examining its depth requires a probe that is inserted along the tooth into the gum line, in different sites of the mouth.

In healthy mouths, this depth doesn’t exceed 1-3 mm! If it went beyond 4 mm this is a sure sign of gum diseases.

X-ray imaging of your teeth to check for bone loss in deeper pockets.

If your dentist suspects any medical cause for the disease, he may advise you to test for blood sugar and other risk factors.

Treatment of gingivitis

If you never took good care of your health and gums, the earlier the treatment, the lower the risk of teeth loss!

Starting with good oral hygiene and cessation of smoking is the first line of treatment!

Treatment provides professional care for your gums for example:

Professional cleaning: this includes removal of all plaque layers, tartar and bacteria.

It is also known as Scaling and root planning! Where scaling is the procedure that involves removal of tartar from tooth and gums while root planning is the procedure that removes the bacterial byproducts of inflammation, smoothens out root surfaces and disenables future buildup of tartar and bacteria, eventually allowing proper healing. The dentist could use metallic instruments, laser or ultrasonic devices.

Ill-fitting dentures/crowns/bridges and misaligned teeth could irritate gums and makes the procedure of removing the plaque harder. If these are the causes of gingivitis then our first recommendation is visiting your orthodontist to repair these restorations.

Continuing with your oral care, after professional clearing is the ultimate guideline against recurrence of gingivitis.

Following up with your dentist, oral hygiene plan, professional cleaning you can expect the pink healthy gums within few weeks.

Lifestyle changes

  • To sum up what you can to prevent gingivitis could be summed up into:
  • Brushing your teeth twice daily and after every meal.
  • Better use soft brittle toothbrushes to be replaced every 3 months.
  • If you can afford an electric toothbrush, it can dramatically improve plaque clearance.
  • Floss daily or whenever possible.
  • Mouthwash helps rinse plaque in between your teeth.
  • Professional dental hygienist visits are important too.
  • Stop smoking immediately.

What to expect before, within and after your dentist’s visit?

First, you have to book an appointment with your dentist as part of your regular visits or when you notice any gum disease symptom.

To be ready, please make a list of:

  • Your Symptoms, gum or non- gum related.
  • Medical history.
  • All medications you take including off the counter ones.
  • Any question you wish to ask your dentist.

Within the appointment your dentist may ask you any of the following:

  • When did you have your first symptom?
  • Are they sporadic or continuous?
  • How often do you brush, floss, wash and scale?
  • Any other medical condition you may suffer from and their medications.

After the appointment, the doctor will discuss your treatment options and required lifestyle changes.

Please follow these recommendations for better oral health.

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