Those who don't routinely go to the dentist know that they're at risk of getting gingivitis but what is it and how bad could it be? If you haven't been to the dentist in a few years, should you be concerned about bleeding gums because there are far more pressing matters in your life such as paying off student loans and your mortgage. Is gum disease really that serious?
Table of Contents:
Overview
The literal definition of gingivitis means gum inflammation, which stems from the combination of the two words, "gingiva" (gums) and "-itis" (inflammation). It is often associated with bleeding gums due to infrequent visits to the dentist and negligence of one's oral health.
What is gingivitis?
This dental condition is the beginning stage of gum disease and it only affects the gums around the teeth. It typically causes mild symptoms but if left untreated, it may progress to a more severe form of gum disease called periodontitis, which can result in bone loss or even tooth loss.
Fortunately since gingivitis is only the early stages of gum disease, its effects are reversible and none of the damage is permanent. The more advanced stages however do cause irreversible permanent damage.
How common is it?
Studies have shown that plaque induced gingivitis is the second most common oral disease affecting more than 75% of the population worldwide. It is sometimes referred to as a "silent epidemic" due to the prevalence and how widespread it is.
According to the CDC (Centers for Disease Control and Prevention):
Affects more men than women (56.4% vs 38.4%).
47.2% of adults that are 30 or older have some form of the disease.
Incidence increases with age, 70.1% of 65 and older have it.
65.4% of those living below the poverty line.
66.9% of those with less than a high school education.
64.2% of current smokers.
In addition to adults, it also affects children from as early as 6 years of age. According to this study, the prevalence of gingivitis in developed countries was 73% for those between 6-11 years old.
The rates also increase during puberty.
During adolescence it can increase to 50-99%
Seems to affect more boys than girls.
Symptoms
Here are some of the signs and symptoms of gingivitis:
Swollen gums that look poofy
Dark red gums or discolored
Gums that bleed easily when you brush or floss
Bad breath that doesn't go away
Tender gums
Painful gums
Gum inflammation
Sensitivity teeth to hot or cold foods.
Loose gums
Sensitivity when chewing
Partial dentures that no longer fit
This is in contrast to healthy gums, which are light pink in color and also wrap tightly around the tooth. They also don't bleed easily when you brush or floss because healthy gums are very resilient to all forms of manipulation and stimulation.
Signs and symptoms described in other sensory forms
Smell. A foul odor in your mouth is associated with periodontal disease and individuals with this malodor are sometimes referred to as having perio breath. Gingivitis causes bad breath because the bacteria release a lot of volatile sulfur compounds. A study has shown that tongue scraping, oral hygiene instructions, and gargling with a mouthwash will all reduce the levels of volatile surfur compounds and consequently bad breath.
Taste. Moderate to severe forms of the disease will cause the gums to bleed easily so you may experience a metallic taste. This taste stems from the iron in the blood that comes from your bleeding gums. Consequently it may not be so pleasant to kiss someone with bleeding gums but fortunately, it is not contagious.
Feel. Not just your gums but your mouth overall may feel tender and sore due to active inflammation.
Signs that are NOT indicative of gingivitis
Receded gums. After treatment of gingivitis you may have receded gums but while the disease is active, the gums are so swollen that you can't see any receding gums. It is only after it is treated that you can visualize the recession. Therefore, receded gums are usually a result of completing treatment for gingivitis.
Loose teeth. If your teeth are loose, you are beyond the early stage of gum disease because you've arrived at the advanced stage. It would be an understatement if you had loose teeth and called it gingivitis.
Bone loss. If you're noticing a lot of bone loss and seeing black triangles between your gums, you're beyond gingivitis because you're at periodontitis.
Exceptions
Gingivitis can be very mild and you may not even notice any of the signs or symptoms because of the mildness. In fact, many people don't even know that they have it due to that reason. This is why it is important to go for your dental check ups because your dentist can differentiate between the very mild and severe forms of periodontal disease.
Causes
Gum inflammation from gingivitis is a result of plaque and tartar on teeth being next to the gums causing constant irritation. It is exacerbated by infrequent visits to the dentist and also negligence toward one's oral hygiene because those two factors result in more plaque formation than otherwise.
Stages of Gingivitis - Timeline of formation
Plaque formation on teeth. Using sugar and carbohydrates as a fuel, bacteria will aggregate together to form a thin biofilm called plaque. Plaque is clear to white in color and it sticks to your teeth. Fortunately it is soft and easy to remove, which is why you need to brush it off before going to bed.
Plaque transforms into tartar. Plaque that is not removed before going to bed will harden into tartar (calculus), which is calcified plaque. This calcified substance cannot be eliminated with simple brushing and only your dentist can remove it with their sharp stainless steel instruments.
Gum inflammation. If left unchecked, the tartar will continue to grow in size and even attempt to cover the entire tooth as well as the root surface that is below the gumline. The body rightfully recognizes it as a foreign substance and tries to get rid of it by sending cells to eliminate it and that results in inflammation. The longer the calculus stays next to the gums, the more your gums will be inflamed. Once the gums are irritated enough to start bleeding, you've officially reached the early stages of gingivitis.
That is how you get gingivitis and it is all due to insufficient oral hygiene from forgetting to brush off plaque before going to sleep. Brushing will remove most of it from your teeth but you will also need to floss to get rid of the biofilm in between your teeth.
How long does it take gingivitis to develop?
Gum disease does not happen overnight but rather from inconsistent brushing and flossing over time. It may take up to a few weeks before gingivitis forms and you start to notice bleeding from the gums. Therefore, you have a lot of chances to prevent it since it does not occur immediately.
How long does it last?
It will not go away on its own because the calculus that is causing the gum inflammation cannot be brushed off at home. Only a dental professional such as a hygienist can remove it. Therefore, it will permanently affect your gums until you finally decide to go in for your dental check up and teeth cleaning. It will last until you stop putting off your dental visit.
Other causes
The main cause of periodontal disease is due to plaque and tartar formation but there are other factors which can cause gingivitis.
Hormones from pregnancy. Due to hormonal changes during pregnancy, some women may get gingivitis when they normally don't. It is a result of increased hormones and frequency of eating that lead to more plaque formation. This is preventable as long as oral hygiene is maintained and regular dental check ups are attended. The condition will subside after delivering the baby.
Medications. Certain medications such as immunosuppresants, calcium channel blockers, and anticonvulsants may lead to gum overgrowth and that can increase susceptibility to gum inflammation.
Risk factors
There are risk factors, which may increase one's susceptibility to gingivitis and gum disease.
Poor oral hygiene habits
Smoking or chewing tobacco
Diabetes
Medications such as oral contraceptives, steroids, anticonvulsants, calcium channel blockers, chemotherapy, immunosuppresants, anti-fungals, anti-virals, and etc.
Misaligned teeth and malocclusion
Improper fit of dentures
Broken fillings and other dental restorations
Pregnancy - hormonal changes and more frequent eating
Immunocompromised such as with HIV
Older age
Male
Dry mouth
Poor nutrition - vitamin C deficiency (Scurvy) and diets high in carbohydrates
A lot of these contributing risk factors are lifestyle choices while others are due to genetic or hereditary conditions. They all lead to an increase in risk of getting gingivitis and having gingival bleeding.
Diagnosis
In order to truly know if you have gingivitis you need to be diagnosed by a dental professional. Here are methods your dentist uses to diagnose suspected periodontal disease.
Review dental and medical history. Reviewing past history and family history of health conditions, which may contribute to your symptoms.
Oral examination of teeth, gums, and tongue. To identify presence of plaque, tartar, and redness of gums. Dark red gums are indicative of inflammation.
Measuring gum pockets. Your dentist or hygienist will "probe" your gums to measure how deep they are. A measurement that is 3 mm or below is considered healthy while one that is above that is considered unhealthy.
Dental x-rays. The amount of tartar that is present on the x-rays will give your dentist an idea of how much gum inflammation is present. Therefore, what gingivitis looks like on an x-ray is a lot of tartar on the teeth. The calculus look like white objects hanging off the side of the teeth on x-rays.
Quantifying amount of bleeding during dental cleaning. Your dentist won't know the true extent of how much your gums bleed until they do the teeth cleaning. The more bleeding you have during the procedure, the more severe your gingivitis is.
Other tests. If you have a lot of gum bleeding and it is inconsistent with the amount of plaque or tartar you have, you may have an autoimmune disease. Your dentist would then refer you to your primary care physician to run further tests.
After collecting information from all of these tests, your dentist can then make an accurate determination of whether you have gingivitis.
Self diagnosis at home
You won't be able to definitively diagnose yourself with gingivitis because only a oral healthcare professional can do that. What it can do is give you an idea of whether you should go in sooner for your dental check up.
Signs indicative of gum disease:
Bleeding when you brush your teeth.
Bleeds when you floss.
Gums look red and swollen.
Metallic taste in your mouth.
Gum pain or tenderness.
Treatment
Treatment for gingivitis involves a combination of a teeth cleaning along with at home care. It is necessary to do both because if you do just one without the other, it would be insufficient in reversing the effects of gum disease. The only way to permanently cure it is to utilize everything at your disposal because periodontal disease needs to be managed long term.
How does your dentist treat gingivitis?
Gum disease is treated at the dental office by removing the source of gum inflammation, which is plaque and tartar buildup. The procedure is called a dental prophylaxis or otherwise commonly known as a dental cleaning.
Your dentist will utilize two different instruments to remove the calculus and plaque buildup. The instruments are called hand scalers and ultrasonic scalers.
Hand scalers. These are very sharp stainless steel pick like looking tools that can cut into the calcified tartar. The sharpness is paramount to removing it because a standard toothbrush with its bristles is unable to make a dent in it.
Ultrasonic scalers. This piece of equipment attaches a scaler to a machine that makes it vibrate at over 30,000 revolutions per minute and shoots pressurized water. That intensity of vibration will break up all of the calculus and flush out all of the plaque.
Antibiotics are typically not necessary for treating gingivitis because the primary means to remove the plaque and tartar are mechanical. The antibiotics may be needed if you progress to a more advanced stage of gum disease. However, your dentist may prescribe you chlorhexidine (antibiotic rinse) to help with bacterial control and gum healing.
What to expect for your dental visit:
Your dental check up will start off with taking the necessary x-rays.
Then your dentist will perform an oral examination to assess the teeth for gum disease and tooth decay.
The hygienist will perform a teeth cleaning to remove all of the plaque and tartar from your teeth.
Refine the teeth by going over every nook and cranny with a hand scaler to ensure that all of the plaque is accounted for.
Floss your teeth to remove debris in between the teeth.
Polish your teeth with a fluoride prophy paste.
Rinse your mouth out with a mouthwash like Listerine.
The entire procedure should take between 30-45 minutes to complete. The difference in amount of time required is directly proportional to how much buildup you have on your teeth.
The more buildup you have the more time it would take and conversely, the less you have the less time it would take. Overall, you should be in and out of the dental office within an hour if you include check in and check out time.
How much does it cost?
If you have dental insurance, most PPO plans will cover the treatment at 100%. In fact they'll often cover it at least twice a year in order to encourage you to seek preventative dental treatment.
Just be aware that there are some insurances that may include an annual deductible or they may cover it at less than 100%.
If you do not have dental insurance and are paying out of pocket, the fee will vary based on location. The exam and x-rays are also not included in the cost. Here is some data from a 2020 survey of dental fees by the American Dental Association (ADA).
Average dental cleaning = $97.50
Range of the cleaning fee is between $74-$135
At home care to manage gum disease
After the dental cleaning, your work is not done because plaque constantly rebuilds every hour on the hour. Your dentist does the bulk of the work by getting rid of the hard tartar that causes gingivitis but it is your responsibility remove plaque on a daily basis.
The plaque must be removed so that you prevent the calculus from forming. The good news is that it is very soft and easily removed with gentle brushing with a soft toothbrush. It is of great importance that you brush and floss everyday.
Is gingivitis curable or reversible?
Gum disease is technically not curable because you can always relapse after treatment and the disease returns. Individuals can relapse when they don't return for their 6 month cleaning and check up or they stop maintaining their oral hygiene regime. Therefore, we like to refer to gingivitis as a chronic disease that needs to be managed since it is incurable.
Fortunately, periodontal disease can be reversed because the early stages of gingivitis do not leave permanent damage to your mouth. Usually it'll take about 2-4 weeks for the symptoms to go away after receiving treatment for it. You'll slowly notice the gums changing back to a healthy pink color from the dark red diseased color over the weeks. The gums will also stop bleeding as much.
As long as you maintain good oral hygiene practices, you should be able to prevent it from coming back but if you slip up, complications can arise.
Complications
If gingivitis is left untreated, your gums will either be in a perpetual state of inflammation or the gum disease progresses to the next stage called periodontitis.
Perpetual state of inflammation
You may be surprised but according to this study, some individuals can remain at the stage of gingivitis for many years without progressing to the more advanced stage. It is not completely understood why that is the case but we observe in clinical practice all the time. This means that the affected person will be in a constant state of gum inflammation. The gums will be swollen and bleed all the time but no permanent damage will be done.
We want to emphasize that it does not mean you should stop going to the dentist if you happen to be someone that remains at the early stage of gum disease. Your gums will continue to bleed and the tartar will continue to grow. Even if you're not receiving permanent damage to your mouth, those symptoms have undesirable effects on your lifestyle.
It may ruin your dating life because no one wants to kiss another person with bleeding gums.
There are a lot of associated health conditions such as respiratory disease, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome, and cancer.
It is not healthy to be in a perpetual state of inflammation so we do recommend that you check in with your dentist biannually.
Next stage of gum disease - Periodontitis
The unfortunate ones who are not able to remain at gingivitis will progress to the advanced stage of gum disease called periodontitis. Periodontitis affects more than just the gums because it also involves bone inflammation, which ultimate results in loss of bone and teeth.
The loss of bone and teeth are irreversible and the damages to your mouth are permanent. Therefore it would be prudent to have gingivitis treated as promptly as possible so that you don't risk advancing to this stage of periodontal disease.
In addition to permanent damage, the treatment for periodontitis is more involved and costly. The needed treatment is called a deep teeth cleaning, which is a regular cleaning plus more. The additional part is scaling your teeth and also root planing the root surfaces of your teeth. This procedure is usually not as comfortable so you do require dental numbing for it.
Oral diseases can be transmitted from mother to child
There are studies which show periodontal bacteria can be transmitted between a mother and child. In fact, it is not exclusive to just gum disease because the tooth decay causing bacteria, Streptococcus mutans can also be transmitted as well. That increases the probability of having cavities.
Last but not least, poor periodontal health of the mother is often a risk factor for low birth weight for the baby. It is of utmost importance for the mother to maintain good oral hygiene and a healthy oral health status.
Prevention
Gingivitis is preventable as long as you follow these guideline recommendations to help manage the disease.
Regular dental visits. This means that you should go see your dentist for a dental cleaning and check up every 6 months. Annual dental x-rays are also taken every 12 months to monitor for tooth decay and periodontal disease. If any issues arise, your dental may prescribe treatment to address it sooner rather than later. If you are at higher risk for gum disease, you may need to go more frequently than just every 6 months, it could be every 3-4 months.
Good oral hygiene. You only see your dentist twice a year so for every day in between those two visits, it is all up to you to remove plaque on your own time. You'll need to brush at least 2 minutes twice a day and then floss your teeth before you go to bed. It is also a recommended habit to use a mouthwash at the end to fully rinse out any remaining debris and plaque.
Healthy lifestyle choices. The bacteria in your mouth thrive on sugar and in an acidic environment. Therefore in order to disrupt their ability to cause damage to your mouth, you should minimize the sugar intake as well as acidic foods and drinks. If you simply create an inhospitable environment for the oral bacteria to live in, you'll decrease the chances of you getting gingivitis.
Stop smoking. Those who use tobacco are at higher risk for gum disease and also dry mouth which is another contributing factor.
If you want to go above and beyond preventing gum disease you can also brush and floss after every meal. This is even better than doing it just once in the morning and once at night time. An electric powered toothbrush has also been shown to be more effective at removing plaque.
Best toothpaste
If you were looking for the best toothpaste to fight gingivitis, there isn't one in particular that is leagues above the others. They are all equally effective at preventing gum disease because it is actually the mechanical brushing motion from your toothbrush that gets rid of the plaque. The toothpaste alone without manual brushing will not remove the plaque and bacteria.
Nonetheless, we do recommend using either a fluoride based toothpaste or a hydroxyapatite toothpaste because both of those ingredients have the potential to reverse tooth decay. The other types such as charcoal, xylitol, and fluoride-free don't have the ability to stop cavities.
Best mouthwash
All types of mouthwashes will work fantastically at preventing gingivitis because they either kill bacteria or make the mouth inhospitable for them to live in by neutralizing the acidity.
Listerine. This mouthwash can come either in alcoholic or non-alcoholic forms and both are equally effective. All you need to do is simply rinse for 30 seconds.
Hydrogen peroxide. This is very acidic but studies have shown that it is potent enough to kill 50% of all bacteria with just rinsing 15 seconds.
Salt water. Salt is a natural antiseptic and is very gentle on your mouth so this is the rinse to use if you have any cuts or sores. It is also the preferred rinse for after having a tooth removed.
Coconut oil. A natural alternative mouth rinse would be using coconut oil for oil pulling. The oil has a neutral pH so it can neutralize all of the acids in your mouth. The only downside is that you do need to rinse and gargle with it for 15-20 minutes, which is a long time when compared to the other rinses.
Summary
Gingivitis is the first stage of gum disease but it is preventable when diagnosed early and intervention is implemented. Regular dental cleanings with your dentist along with maintaining a strict oral hygiene protocol will decrease the chances of you getting it.
It is important to treat it early because it can progress to a more advanced stage of gum disease called periodontitis, which does cause permanent irreversible damage.
This article was written by Dr David Chen, a general dentist in long island city.
