Gingivitis: Symptoms, Causes, Treatments, and Prevention

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

Gingivitis, or bleeding, inflamed gums, is the first stage of gum disease, usually caused by plaque buildup under the gumline. This common dental condition impacts nearly half of adults over 30. If not addressed early, gingivitis leads to serious periodontal disease and may result in tooth loss and gum recession.

If your gums are bleeding, what’s the big deal?

What if you washed your hands and your skin started to bleed? What if you brushed your hair and your scalp started to bleed?

Those would be major signs that something isn’t right. And your gums are no different.

While a tiny bit of blood shouldn’t land you at an emergency dental visit, there’s no reason to be okay with any blood in your mouth. Ever.

The good news? Gingivitis can be reversed with good oral hygiene, a healthy diet, and an understanding of the oral microbiome.

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What is gingivitis?

Gingivitis is inflammation of the gums (gingiva) caused by infection and inflammation. It’s the early stage of gum disease and usually identified first by bleeding gums.

If you don’t address gingivitis, it will eventually progress to full-blown periodontal disease (periodontitis). This painful condition causes gum recession and is associated with nearly every major disease. 

Sadly, 42% of adults over 30 have some form of periodontitis. 7.8% of these adults have “severe” periodontitis, according to the American Dental Association (ADA). 

The CDC reports that after the age of 65, over 70% of adults suffer from periodontal disease. Periodontitis is more common in low-income communities and in men, particularly smokers.

The major difference between gingivitis and periodontitis is that gingivitis has not yet resulted in bone loss. Once bone loss has set in, you risk losing teeth.

Types of Gingivitis

Gingivitis is generally divided into two categories: dental plaque-induced gingivitis and non-plaque induced gingivitis.

The American Academy of Periodontology introduced new guidelines for classifying gingivitis in 2018:

  • Dental plaque-induced gingival conditions: Responsible for the majority of gingivitis cases, this type of gingivitis happens as a result of plaque buildup. It is associated with poor home care of teeth, poor diet, and high levels of all-body inflammation. Plaque-induced gingivitis may be made worse by medications, certain systemic disorders, and hormones (particularly during pregnancy).
  • Non-plaque-induced gingival diseases: Rarely, gingivitis occurs as a result of specific conditions or trauma to the teeth. Common cause of non-plaque-induced gingivitis include: 
    • Genetics
    • Specific bacterial, viral, or fungal infections
    • Inflammatory and autoimmune diseases
    • Pre-malignant or cancerous lesions
    • Metabolic conditions
    • Scurvy (vitamin C deficiency)
    • Trauma to the gums (chemical or physical)

Gingivitis Symptoms

Healthy gums are pale, pink, strong, and snugly wrapped around your teeth.

When gingivitis begins, the condition of your gums may start to change. Symptoms of gingivitis include:

  • Bleeding gums
  • Swelling/inflammation
  • Red or purple gums
  • Painful, tender gums
  • Bad breath
  • Itchy gums

As an aside: many people think that black gums are a sign of gingivitis. Although black gums or black spots on gums can signal some serious issues, they aren’t gum disease symptoms.

What causes gingivitis?

Gingivitis is typically caused by plaque and tartar buildup below the gumline, which triggers inflammation. 

Dental plaque develops when pathogenic oral bacteria grow out of control and collect under the gums. When plaque remains on the teeth too long, it hardens and becomes tartar. 

Most often, gingivitis is caused by one or more of the following factors:

  • Poor oral hygiene, such as a lack of daily brushing and flossing
  • Weakened immunity, like with an autoimmune condition such as Sjogren’s or poor overall health
  • Antibacterial mouthwash, which actually causes a daily overgrowth of harmful bacteria by destroying the oral microbiome
  • Poor diet, high in sugar and low in nutrient-dense foods
  • Smoking or chewing tobacco, which destroys gum tissue, increases inflammation, and destroys overall health
  • Hormonal changes, such as those during pregnancy, menopause, or menstruation

Less frequently, you may develop gingivitis due to:

  • Bacterial, viral, or fungal infections (including oral thrush)
  • Genetic disorders, primarily hereditary gingival fibromatosis (HGF)
  • Inflammatory or autoimmune diseases
  • Metabolic disorders
  • Precancerous or oral cancer lesions (like leukoplakia)
  • Scurvy (vitamin C deficiency)
  • Trauma to gum tissue

Gingivitis Risk Factors

While anyone can develop bleeding gums, certain factors can increase your risk of gingivitis. 

Gingivitis risk factors include:

  • Dry mouth: Mouth breathing and other causes of dry mouth, such as medications or advanced age, can cause bacterial overgrowth in the mouth.
  • Lack of dental care/professional cleanings
  • Sleep disordered breathing: An estimated 40-50% of the population has some form of this, which includes sleep apnea, upper airway resistance syndrome (UARS), and more.
  • Aging
  • Aggressive brushing or flossing
  • Osteoporosis
  • Genetics
  • Poorly done dental work that is difficult to clean
  • Poor nutrition due to gut issues that interfere with nutrient absorption 
  • Wisdom teeth eruption
  • Prescription drugs including antihistamines, calcium channel blockers, phenytoin (a seizure medication), any immunosuppressant such as cyclosporine, and blood pressure medications

Diagnosis

To diagnose gingivitis, your dentist or dental hygienist will physically check for symptoms of bleeding gums. He or she will take pocket depth readings of your gums to determine the level of inflammation.

Your dentist will probably recommend x-rays to check for signs of loss of jawbone tissue to rule out more advanced periodontal disease.

Gingivitis Treatments

Is gingivitis reversible? Yes, gingivitis is reversible. In most cases, mild to moderate gingivitis may clear up with just 2-3 weeks of proper home care and a professional cleaning.

Several gingivitis treatments, at home or at your dentist, can effectively reverse this condition before it leads to jawbone loss or more serious problems.

Unfortunately, many conventional ideas about treating gingivitis are based on outdated science.

For instance, mouthwash is one of the worst things to do for bleeding, infected gums. It’s not a gingivitis cure! For one, it disrupts the oral microbiome, which needs bacteria in order to prevent gingivitis.

To stop gingivitis, you must address the root cause, which is a buildup of the “bad” bacteria in your oral microbiome.

Professional Treatment

The most effective professional treatment for gingivitis is a teeth cleaning. You should see your dental professional for a cleaning every 6 months (or more often, if prescribed). During a dental cleaning, your dental hygienist will remove plaque and tartar from your teeth.

If your dentist is concerned about gum disease, he or she may send you to a periodontist. A periodontist may recommend you have a scaling and root planing every 3 months. This deep teeth cleaning is a standard treatment for periodontitis.

Home Care

Home care techniques for gingivitis include:

  • Daily brushing: Brush your teeth every day after you wake up, right before bed, and 45 minutes after eating sugary, acidic, or processed foods or drinks. Only use a soft toothbrush (preferably an electric toothbrush) and be sure to replace it every 1-3 months.
  • Daily flossing: Flossing at night before bed (before you brush) removes food particles before they attract bacteria to concentrate in one area. Flossing is one of the most important parts of good oral health! Try a water flosser or floss sticks if you struggle to use string floss.
  • Oral probiotics: Chewable probiotics with specific strains of healthy oral bacteria are proven to reduce symptoms of gum disease, including bleeding gums.
  • Oil pulling: Coconut oil pulling can greatly reduce plaque under the gumline in as little as 3 days and reduce gingivitis-related inflammation.
  • Tongue scraping: Scraping your tongue every day can prevent bacteria buildup on your tongue and reduce gum inflammation from gingivitis.
  • Mouth tape: Using mouth tape while you sleep prevents dry mouth due to mouth breathing at night. If you snore or experience daytime sleepiness, you are probably mouth breathing during sleep.
  • Curcumin gel: A 2014 clinical trial found that curcumin gel (made from the active ingredient in turmeric) reduced inflammation and improved the color of the gums in each subject after 3 weeks.
  • Baking soda toothpaste: A toothpaste with baking soda may improve gingivitis by reducing plaque and bleeding.

When to see your dentist

Bleeding gums are not a dental health problem that should send you to the dentist for an emergency appointment. However, there are a few concerning signs that necessitate a dental visit.

If you experience any of the following, talk to your dentist right away:

  • Painful gums that do not improve after several days of gingivitis home care
  • Extremely bad breath
  • Oral pain that disrupts normal activities (talking, sleeping, working, etc.)
  • Loose teeth

Remember, you should have a cleaning every 6 months as a preventative measure for gingivitis. If your last cleaning was more than 12 months ago, schedule one as soon as possible.

How to Prevent Gingivitis

Many methods used to reverse gingivitis can prevent it before it begins, too. 

To prevent gingivitis:

  • Brush your teeth twice a day and 45 minutes after consuming sugary, acidic, or processed foods
  • Floss every day
  • Scrape your tongue every day
  • Oil pull 1-2 times per week
  • Mouth tape
  • Avoid breathing through your mouth during the day
  • Use a sonic toothbrush, such as the Boka
  • Use only soft-bristled toothbrushes (never medium or hard bristles, which can irritate the gums)
  • Replace your toothbrush or toothbrush head every 1-3 months
  • Never skip your bi-yearly dental cleanings
  • Avoid antibacterial/antiseptic and/or alcohol-based mouthwashes/mouth rinses
  • Follow a diet rich in nutrient-dense foods and low in sugar, acidic, and highly processed foods
  • Quit smoking, vaping, chewing tobacco, or any use of tobacco products
  • Talk to your doctor about adjusting or changing medications that cause chronic dry mouth
  • Closely manage your blood sugar if you have diabetes (uncontrolled diabetes will worsen gum disease symptoms)

Complications of Untreated Gingivitis

Once gingivitis progresses into stages II, III, and IV periodontitis, your risks for other diseases can increase significantly. Some of these include:

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FAQs

Q: Is gingivitis contagious?

A: Gingivitis itself is not contagious. However, the bacteria that cause gingivitis can be passed during kissing or even by parents and children sharing utensils.

Q: Which bacteria are responsible for gingivitis?

A: You’ve heard a lot about these ‘harmful’ bacteria, but which ones are they exactly? Here are some of the main gingivitis-casing bacteria:

These are some of the harmful bacteria which need to be limited, but not completely removed, in your oral microbiome. Their existence is vital to the ecosystem of the oral microbiome in its entirety.

It’s the ratio of these bad bugs to the good bugs that makes the difference. External factors such as diet have an effect on the ratio. Using strong, caustic mouthwashes may make your breath smell minty for 10 minutes, but immediately alters this ratio.

Q: Is gingivitis an autoimmune disease?

A: Gingivitis may, in some cases, be classified as an autoimmune disease.

Research has found that gingivitis causes a person’s immune system to produce inflammatory cytokines. This causes inflammation in the gums and the rest of the body.

While you want some cytokines because they help fight infection, too many cytokines contribute to chronic inflammation.

In particular, your mouth is impacted by cytokines interleukin-1beta, interleukin-18, and tumor necrosis factor-alpha (TNF-alpha). These run rampant in a mouth with gingivitis and cause damaging inflammation. 

Also, your white blood cells produce matrix metalloproteinases (MMPs) enzymes, which destroy connective tissue.

Inflammation and autoimmune disease go hand-in-hand. It’s still not clear which comes first, inflammation or autoimmunity.

Q: Is trench mouth the same thing as gingivitis?

A: Trench mouth is a rare, severe form of rapidly worsening gingivitis. In underdeveloped countries or places with exceptionally bad nutrition, some younger people can develop this form of gum disease. 

Named for its historical roots during World War I, trench mouth isn’t common in first world countries except for people with HIV/AIDS, smokers, or people with otherwise compromised immune systems.

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