Gingivitis

Gingivitis is a common gum disease characterized by inflammation, swelling, redness, and irritation of gingiva or gum lines. It should be treated as soon as possible as it can lead to periodontitis and tooth loss.

Improper oral care is the cause of gingivitis. It can be prevented by brushing your teeth twice a day, flossing at least once a day, and seeing your dentist once a year.

Symptoms
Healthy gums are pale pink, firm, and hug tightly around the teeth.

When you have gingivitis, you will experience:

• Swollen, tender, and dark red gums
• Easily bleeding gums during flossing or brushing
• Receding gums
• Bad breath

You should see your dentist when there are signs and symptoms of gingivitis.  Gingivitis and periodontitis can be prevented with regular proper dental hygiene.

Causes
Gingivitis results from poor oral hygiene, which leads to plaque formation and inflammation of the gums.

• Dental plaque. Interaction of invisible bacteria with starchy or sugary foods in your mouth leads to plaque formation and sticky biofilm, which needs to be brushed off daily as it can re-form quickly.
• Tartar. Tartar or calculus is hardened calcified plaque coating your teeth and gum, which is hard to remove. In addition, it irritates your gums and can only be removed by professional dental scaling.
• Gingivits. The accumulation of plaque and tartar irritates the gumlines. As a result, your gums start to swell, inflamed, and bleed easily, leading to tooth decay. If left untreated, it will lead to periodontitis and eventual teeth loss.

Risk factors
Gingivitis can affect everyone, with higher risks in the presence of the following factors:

• Poor oral hygiene
• Dry mouth
• Tobacco chewing or smoking
• Malnutrition and deficiency of vitamin C
• Older ages
• Improper tooth caries filling or crooked teeth
• Medical conditions including leukemia, HIV/AIDS, cancer treatment, and certain viral or bacterial infections
• Certain epilepsy medications, calcium channel blockers, anti-hypertensive medications
• Hormonal changes of pregnancy, menstruation, and taking birth control pills.
• Genetics

Complications
Chronic gingivitis may lead to complications such as cerebrovascular and coronary artery diseases, diabetes, respiratory diseases, and rheumatoid arthritis because bacteria causing periodontitis may enter the bloodstream through the inflamed gums. However, more research is needed.

Trench mouth or necrotizing ulcerative gingivitis (NUG) is a severe form of gingivitis. It is an infection that causes pain, bleeding gums, and ulcerations.

Prevention

• Oral hygiene. Brush your teeth at least 2 times a day - in the morning and before bedtime – or even after a meal, and floss before you brush to remove food particles.
• Regular dental checkups. Have a professional dental cleaning every 6-12 months. If you smoke, take certain drugs, or have a dry mouth, you have a greater risk of developing periodontitis. See your dentist more often and obtain annual dental X-rays, which can reveal dental problems not detectable by general dental examination.
• Healthy eating. Eating healthy foods and controlling blood sugar if you have diabetes is helpful to your robust gum health.

Diagnosis

• Your dentist will review your dental and medical history for conditions that may contribute to your gum problem
• Your teeth, gums, tongue, and mouth will be examined for plaque and inflammation.
• Gum pocket measurement is to gently insert a dental probe into the area between your gum and tooth at multiple sites in your mouth. The pockets are usually 1-3 mm deep in a healthy mouth. However, if you have gum disease, the pockets can be deeper than 4 mm. If you have deep gum pockets, dental X-rays may be taken to assess tooth bone loss.
• Other tests may be necessary if the cause of gingivitis cannot be pinpointed.

Treatment

• Dental cleaning by your dentist. Your dentist performs scaling and root planning to remove plaque and tartar. Scaling removes tartar and bacteria from the teeth surface and below the gum line, and root planning removes bacteria causing inflammation and smooths out the surfaces of the root of your teeth to prevent recurrent tartar and bacteria buildup so your gums can heal. Your dentist may use dental instruments, a laser, or an ultrasonic device to perform the dental cleaning.
• Dental restoration. If you have a dental restoration that irritates your gums and makes brushing teeth difficult, consults your dentist.

Regular oral care
After professional cleaning by a dentist, gingivitis will improve, and the gums will become pink again, especially when you maintain good oral hygiene. You should consult your dentist for a correct dental routine.

Lifestyle modification and oral home care
To prevent recurrent gingivitis, these are things that you can do at home.

• Brush your teeth 2 times a day or after a meal
• Use a soft toothbrush and replace it quarterly
• Use an electric toothbrush which is more effective in removing plaque and tartar
• Floss regularly
• Use a mouthwash to reduce plaque accumulation
• Use an interdental cleaner such as a dental pick or internal brush suitable for cleaning between your teeth in addition to regular brushing and flossing
• Visit your dentist regularly
• Avoid smoking or tobacco chewing

Preparing for your appointment
Keep all dental appointments, and consult a dentist if you have incipient gingivitis

Before your appointment, prepare a note of:

• Existing symptoms, regardless of whether they are associated with gingivitis
• Your personal information, including medical conditions
• Medications or dietary supplements you are taking
• Questions you would like to ask your dentist

Sample of questions you may ask your dentist:

• What is the cause of gingivitis?
• Do I need to undergo any additional tests?
• Are treatments covered by insurance company?
• Are there alternative treatments?
• What is the dental care routine I should do at home?
• Do you recommend any particular types of toothpaste, toothbrush, or dental floss?
• Is mouthwash necessary?
• Are there anything I should avoid?
• Where can I find more information about dental hygiene?

Sample of questions your dentist may ask you:

• When did the symptoms start?
• Do you experience the symptoms regularly or intermittently?
• How often do you brush or floss your teeth?
• How often do you see a dentist?
• Do you have any medical conditions?
• Are you currently taking any medications?