Symptoms

Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, you may have gingivitis. Because gingivitis is seldom painful, you can have gingivitis without even knowing it. Signs and symptoms of gingivitis may include:

• Swollen gums
• Soft, puffy gums
• Receding gums
• Occasionally, tender gums
• Gums that bleed easily when you brush or floss, sometimes seen as redness or pinkness on your brush or floss
• A change in the color of your gums from a healthy pink to dusky red
• Bad breath

When to see a dentist
Most dentists recommend regular checkups to identify gingivitis, cavities (caries) and other dental conditions before they cause troubling symptoms and lead to more-serious problems. Also schedule an appointment with your dentist if you notice any signs and symptoms of gingivitis. The sooner you seek care, the better your chances of reversing damage from gingivitis and preventing its progression to more-serious conditions.

Causes

The most common cause of gingivitis is poor oral hygiene that encourages plaque to form. Plaque is an invisible, sticky film composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing and flossing your teeth each day removes plaque. Plaque requires daily removal because it re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar makes plaque more difficult to remove and creates a protective shield for bacteria. You usually can't get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.

The longer that plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

Risk factors

Gingivitis is very common, and anyone can develop it. Many people first experience gum problems during puberty and then in varying degrees throughout life.

Factors that can increase your risk of gingivitis include:

• Poor oral health habits
• Tobacco use
• Diabetes
• Older age
• Decreased immunity as a result of leukemia, HIV/AIDS or other conditions
• Certain medications
• Certain viral and fungal infections
• Dry mouth
• Hormonal changes, such as those related to pregnancy, your menstrual cycle or use of oral contraceptives
• Poor nutrition
• Substance abuse
• Ill-fitting dental restorations

Complications

Untreated gingivitis can progress to gum disease that spreads to underlying tissue and bone (periodontitis), a much more serious condition that can lead to tooth loss. Periodontitis and poor oral health in general may also affect your overall health in ways that aren't completely understood. Studies link periodontitis to an increased risk of heart attack, stroke or lung disease. And women with periodontitis may be more likely to give birth to premature babies or babies with low birth weight than are women with healthy gums. Although more research is needed, these studies highlight the importance of taking good care of your teeth and gums.

Preparing for your appointment

Follow your dentist's recommended schedule for regular checkups. If you notice any symptoms of gingivitis, make an appointment with your dentist. Here's some information to help you get ready for your appointment and know what to expect from your dentist.

What you can do
Consider preparing a list of questions to ask your dentist. Some questions you may want to discuss include:

• Do you think gingivitis is causing my symptoms?
• What kinds of tests, if any, do I need?
• Will my dental insurance cover the treatments you're recommending?
• What are the alternatives to the approach you're suggesting?
• What steps can I take at home to keep my gums and teeth healthy?
• What kind of toothpaste do you recommend?
• How often should I brush?
• What kind of toothbrush do you recommend?
• What kind of dental floss do you recommend?
• How often should I floss?
• Do you recommend use of mouthwash?
• Are there any restrictions that I need to follow?
• Are there any brochures or other printed material that I can take home with me?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment at any time if you don't understand something.

What to expect from your dentist
Your dentist may ask you questions about your symptoms. He or she may ask:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How often do you brush your teeth?
• Do you use dental floss? How often?
• What medical conditions do you have?
• What medications do you take?

Tests and diagnosis

Dentists usually diagnose gingivitis based on symptoms you describe and an examination of your teeth, gums, mouth and tongue. Your dentist will look for plaque and tartar buildup on your teeth and check your gums for redness, puffiness and easy bleeding.

If it's not clear what has caused your gingivitis, your dentist may recommend that you get a medical evaluation to check for underlying health conditions.

Treatment and drugs

Prompt treatment can usually reverse symptoms of gingivitis and prevent its progression to more serious gum disease and tooth loss. Effective treatment requires professional care followed by stepped up oral hygiene at home.

Professional gingivitis care includes:

• An initial evaluation and thorough dental cleaning to remove all traces of plaque and tartar
• Instruction on effective daily home brushing and flossing techniques
• Regular follow-up professional checkups and cleaning
• Fixing dental restorations that hinder adequate hygiene, if necessary

Follow-up home care includes:

• Brushing at least twice a day. An electric toothbrush may help you brush more effectively.
• Flossing at least daily.
• Using an antiseptic mouth rinse, if recommended by your dentist.

Your initial professional cleaning will include use of dental instruments to remove all traces of plaque and tartar — a procedure known as scaling. Scaling may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup.

Misaligned teeth or poorly fitting crowns, bridges or other dental restorations may irritate your gums and also make it harder to remove plaque during your daily home care. If any of these conditions is contributing to your gingivitis, your dentist may recommend fixing these problems.

Gingivitis usually clears up after a thorough professional cleaning — as long as you continue to follow a program of good oral hygiene at home. Your dentist will help you plan an effective home follow-up program. He or she will review brushing and flossing techniques to make sure you're getting maximum benefit from your home cleaning. Your dentist may also recommend using an antiseptic mouth rinse to help clear away bacteria.

If you're consistent with your home hygiene, you should see the return of pink, healthy gum tissue within days or weeks. You'll need to practice good oral hygiene for life, however, so your gum problems don't return.

Lifestyle and home remedies

Care at home plays a key role in preventing and reversing gingivitis. Steps you can take at home include:

• Get regular professional dental cleanings, on a schedule recommended by your dentist.
• Use a soft toothbrush and replace it at least every three to four months.
• Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
• Brush your teeth twice a day, or better yet, after every meal or snack.
• Floss at least daily.
• Use an antiseptic mouthwash, if recommended by your dentist.
• Use an interdental cleaner, such as a dental pick or dental stick specially designed to clean between your teeth.
• Don't rely on tartar-control toothpaste to do the job that brushing and flossing should do.

Prevention

The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.

Also, see your dentist or dental hygienist regularly for professional cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing gingivitis, you may need professional dental cleanings more often.