What Is Gingivitis?

The gingiva (plural - gingivae), also known as the gum, is the soft pink tissue that surrounds your teeth. It has several functions including support, protection and aesthetics. The gingiva is impressive in its defense of the teeth, where it acts as a seal to prevent penetration of harmful bacteria below the gum margins. Good oral hygiene coupled with a healthy diet will help keep your gums healthy. 

Gingivitis is the inflammation, discolouration, and change in texture, contour, and size of the gingivae (gums). Are you wondering how to identify these changes as soon as they occur, why your gums bleed during toothbrushing and if it is normal, or why older people tend to progressively lose their teeth?

In this article, we will be discussing how gingivitis can lead to more dangerous gum diseases. 

Overview

Gingivitis is a common gum problem that affects more than half of the population.¹  
The term gingivitis simply refers to inflammation of the gums. This happens when there is increased blood flow to the gums as a result of the body's response to local or systemic factors. These factors may range from oral hygiene, host’s immunity or even diet as will be further discussed in this article.²

Causes of gingivitis

Dentists generally believe that the single most significant cause of gingivitis is dental plaque.³ These are biofilms (cohesive films of bacteria) that get stuck to the teeth, especially at the junction of the tooth and the gum. When the dental plaque build up is enough to produce irritants, it results in gingivitis which is the initial and reversible stage of gum diseases. These biofilms take just about 4 hours to form on the teeth but thankfully, daily toothbrushing saves us from its further accumulation to the level of forming irritants that result in gingivitis.

Other less common causes exist and these include but are not limited to certain medications, Vit-C deficiency, etc.

Signs and symptoms of gingivitis

The red flags that point to gingivitis; 

• Appearance: healthy gums are usually coral pink in color, stippled when dry with some variations in color depending on the level of melanin. However, in gingivitis, a reddish appearance of the gum is seen. An overly smooth and puffy gum may also be noticed 
• Bleeding: healthy gum tissues do not bleed spontaneously or on slight probing. However, in gingivitis the gum bleeds easily when slightly probed, during brushing and sometimes spontaneously
• Size: the size of the gums can vary but they should not cover above the crown so as to appear more pronounced. In gingivitis, however the gums appear enlarged and swollen.
• Texture: healthy gums are firm. In gingivitis the gum tissue may feel softer or spongier than normal
• Gum tenderness/pain: This is not a common symptom but is possible especially while chewing or during brushing. 
• Initiation of gum pockets: because of the swelling, there appear to be pseudo-pockets between the gum and the teeth in which bacteria can easily hide away and multiply to further cause advanced gum disease called periodontitis.

Gingivitis oftentimes comes with no pain which is why it remains undetected for long time.
It is therefore important that a dental professional is consulted as soon as any of the symptoms are observed for early detection and treatment

Management and treatment for gingivitis

Bearing in mind that gingivitis is reversible and the commonest cause is dental plaque, the mainstays of management are:

Professional dental care: 

This is recommended every 6 months and may include:

• Scaling and polishing: this is the process by which plaque and tartar (hardened plaque) are removed from the tooth surface typically by a dental hygienist.
• Oral hygiene instruction and motivation:  Personal oral hygiene habits will be reviewed and recommendations made. Some of the advice may include brushing the teeth at least twice daily, teeth flossing at least once daily, and chemical plaque control may also be suggested via the use of mouthwashes but only as an adjunct to toothbrushing.

Lifestyle and dietary changes

• A Healthy diet that includes a lot of fruits and vegetables especially those rich in Vitamin-C will help maintain gum health. 
• Quitting smoking: smoking can worsen gum disease and delay healing of the gums hence why it is advised to quit smoking as far as oral health is concerned. 

Diagnosis

Diagnosis of gingivitis will require a visit to the dental clinic where it is typically diagnosed by a dental professional during dental examination. A holistic examination usually entails:

• Review of Dental History: The dental professional may ask questions about oral hygiene and symptoms like bleeding during brushing, bad breath etc.
• Dental examination: the dental professional will go ahead to inspect the gums for  change in color, contour, size etc. Gentle probing with a dental probe will also be done to determine if gums bleed easily. A periodontal probe will also be used to measure the depth of the gum space. Deeper pockets can be a sign of advanced gum disease
• Dental x-rays may be taken if advanced gum disease is suspected but not routine for gingivitis. 

Based on the assessment, a diagnosis of gingivitis or advanced gum disease can be made.                                                                                                                                                                                           

Risk factors

There are various factors that affect the initiation or progression of gingivitis which include; ⁴

• Oral hygiene: Good oral hygiene habits like daily brushing and flossing go a long way in preventing build-up of dental plaque and hence gingivitis. Poor oral hygiene therefore is directly associated with gingivitis 
• Hormonal changes: studies have shown pregnant women to be more susceptible to gingivitis due to hormonal changes. This means that at even lower levels of dental plaque accumulation, a pregnant woman is more likely to experience gingivitis when compared with the general population.⁵
• Diabetic status:  higher sugar levels associated with diabetes tend to cause biological changes that reduce the host’s ability to adequately defend the gums from dental plaque bacteria, hence leading to faster progression into periodontitis. ⁶ 
• Immune status: Immunodeficiency affects the ability of the host’s body to respond to plaque bacteria as they should. 
• Tobacco use: smoking also constitutes a risk as it weakens the body's immune system.⁷

Complications

If the irritant is allowed to continue building up, it will advance further down the gum line destroying the fibers attaching the gum to the teeth and creating a crater in between the gum and the tooth, which reduces access for effective cleaning. These bacteria multiply and further advance to attack the other supporting tissues of the tooth including the bones. 

Ultimately the tooth support gets weakened and the tooth loosens up. At this point, the condition is referred to as periodontitis which if left unchecked, may cause tooth loss. In fact, a study amongst the US population found that periodontitis is the most common cause of tooth loss in adults.⁸

The longer the plaque builds up with age, the more severe the periodontal disease which ultimately results in tooth loss. This might explain the erroneous belief that old age is associated with tooth loss, which is all a myth. The teeth can last well into old age if preventive measures are taken to promote gum health.

Warning signs that gingivitis has transitioned to periodontitis.⁹

• Bad breath or foul taste that won’t go away
• Gum pain while chewing
• Loose or shifting teeth
• Gum recession and Sensitive teeth
• Gums that have pulled away from your teeth
• Any change in bite or difficulty biting
• Changes in the fit of partial dentures

These warning signs may present with some of the symptoms of gingivitis, including redness, bleeding, and swelling.

FAQs

How can I prevent gingivitis?

Good oral hygiene measures and regular visits to the dentist are usually helpful in preventing Gingivitis. 

How common is gingivitis?

A study shows that about 90% of the population have varying degrees of gingivitis 

Is gingivitis contagious?

Gingivitis is not contagious. However, bacteria can be transferred via saliva without the development of gingivitis.  

When should I see a doctor?

You should see a doctor as soon as you notice any of the signs of gingivitis(gum redness, swelling or bleeding during brushing)

Summary

While gingivitis is a mild gum disease, it can potentially lead to periodontitis if not treated. The good news, however, is that gingivitis is preventable and reversible with early diagnosis and prompt treatment. By maintaining a good oral hygiene practices such as daily toothbrushing, flossing, and regular dental visits, you can reduce the risk of developing gingivitis or periodontitis and have your teeth serve you well into old age.