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When it comes to oral care, people usually focus most of their efforts on keeping their teeth healthy. The state of their gums or gingiva is usually neglected.
The gingival tissue forms the foundational structure that anchors your teeth in place.
The roots, or the lower two-thirds of your teeth, are extremely sensitive and need to be protected from the onslaught of oral bacteria/plaque.
The base of the tooth is covered by a protective layer of gingival tissue. Without the gingival tissue, the exposed roots will get damaged easily and the tooth will eventually become unhinged.
What is Gingivitis?
Gingivitis refers to the initial stage of gum disease that is characterized by inflammation or swelling of the gum tissue surrounding the teeth.
Negligent oral hygiene allows the bacteria in your mouth to flourish. These oral bacteria eventually settle on and around the teeth in the form of a sticky biofilm called plaque.
The slimy coating of bacteria gradually hardens to form calculus, which stains your teeth and is much harder to remove.
In most cases, the swelling in your gums is the result of this type of plaque buildup. However, the gum inflammation often goes unnoticed as gingivitis rarely causes any pain.
The base of your tooth becomes vulnerable to infection and rampant decay because the integrity of your gingival lining is compromised by the bacteria.
Thus, an untreated case of gingivitis may take a serious turn and cause an actual infection of the gums called periodontitis.
This form of gum disease can become extremely painful in advanced stages. It may even lead to loss of the affected tooth.
Gingivitis Versus Periodontitis
Gingivitis is a precondition for periodontitis. The former is marked by an inflammation or swelling of the gums, whereas the latter occurs when the gums become diseased or infected.
Types of Gingivitis
Gingivitis has two types:
Dental plaque-induced gingival disease
The most common culprit for gingivitis is dental plaque. If you do not clean your mouth adequately or regularly, oral bacteria multiply, eventually forming a sticky layer of plaque over the teeth and gums.
The gingival tissue becomes inflamed in response to the bacterial buildup and not due to any other local contributing factor.
Non-plaque-induced gingival lesions
Sometimes, the swelling in your gums can be traced back to factors other than oral plaque, including the following:
- An underlying systemic condition, such as an allergic reaction or certain ailments
- Certain pathologic changes in the gum tissues triggered by a specific microbial agent
- Genetic predisposition to forming gingival lesions
- Trauma or injury to the gingival lining
- A reaction to foreign bodies, such as dentures
- Idiopathic cause, which means you cannot pin the swelling on any one specific cause (1)
What Causes Gingivitis?
The most common cause of gingivitis is plaque build-up due to improper oral hygiene. Plaque is an invisible sticky film of bacteria that can irritate your gum tissues and teeth.
What are the Symptoms of Gingivitis?
The symptoms associated with gingivitis include:
- Bleeding gums (first visible sign of inflammation)
- Swollen, red gums
- Bad breath (also called halitosis)
- Receding gums and calculus buildup
- Gums that have pulled away from the teeth
- Gums that may be tender on brushing and flossing sometimes
- Swelling around a tooth
- Spacing and movement of teeth, called pathological migration (Spacing between teeth could be due to other reasons too.)
- Loose teeth
A dentist conducts a detailed evaluation of your teeth and gums to check for tooth decay and plaque formation. The shape and color of the gingival tissue are examined on both sides of the tooth.
The dentist records the amount of plaque and tartar on your teeth, swelling and inflammation of the gums, and the presence of ulcers or abscesses.
Your teeth sensitivity would also be observed. The dentist would also check if there is mobility in your teeth to determine bone loss.
Dental X-rays help in the diagnosis when tooth decay is in its initial stages and has not resulted in oral cavities. They may also indicate how much of the gum is affected due to decay and if bone loss has taken place.
Dental Treatment for Gingivitis
Practicing a complete oral hygiene routine can help you deal with gingivitis. It consists of brushing your teeth two times daily with a soft brush, rinsing your mouth with a mouthwash, and flossing adequately.
It is recommended to visit your dentist at least twice a year for a thorough dental checkup and professional teeth cleaning if needed.
After assessing your oral cavity, your dentist may suggest additional oral health measures to remove the plaque and tartar from your teeth and gums.
To address plaque-induced gingivitis, your dentist may prescribe an antibiotic treatment to reduce the bacterial load in your mouth. This inhibits further plaque formation.
Various antibiotic therapies can be used in this regard.
Your doctor may write down a short course of antibiotic pills or capsules that have to be taken orally or recommend topical antiseptics to be applied directly to the gums.
Additionally, certain antibiotic solutions may be prescribed as mouthwash to disinfect the oral cavity.
Antibiotic administration at the very onset of the gingivitis can help reverse the plaque-induced damage and reduce the risk of infection or periodontitis.
By killing the bacteria responsible for gingivitis, antibiotics help your gums heal better and faster.
Side Effects of Antibiotics
However, one cannot rule out the possibility of side effects when being treated with antibiotics. Antibiotic pills, in particular, are known to trigger the following side effects in patients with gingivitis:
- Digestive distress, which may lead to diarrhea
- Shortness of breath
- Facial puffiness or swelling
- Bad taste in the mouth
Gingivitis is a relatively mild form of early-stage gum disease, which usually causes painless swelling in the gums.
However, if your condition worsens or advances to a more severe form of gum infection, it may give rise to a considerable degree of pain.
In such a case, you may need a painkiller, such as paracetamol and ibuprofen, to manage the discomfort. Over-the-counter analgesics are effective when the pain is relatively mild.
It is always better to consult your doctor about the appropriate drug and dosage instead of self-medicating.
Moreover, remember that pain medicine does not work as a standalone treatment for gum disease. It has to be used in conjunction with the doctor-prescribed antibiotics.
Toothpaste is a mild abrasive used for cleaning the surface of the tooth. It acts as an antiplaque and anti-inflammatory agent if it contains antimicrobial components.
Some of the active ingredients in toothpaste include amine alcohols, chlorhexidine, enzymes, herbal products, quaternary ammonium compounds, triclosan, zinc salts, and fluoride salts.
Fluoride toothpaste is considered to be the go-to oral hygiene product for the preservation and promotion of oral health.
But toothpaste that contains triclosan in addition to fluoride may provide a stronger cleaning action in reducing your plaque scores.
If you wish to prevent gingival inflammation and gingival bleeding, choose a toothpaste that contains not just one but two protective agents. (2)
Toothpastes and dentifrices, when used on a toothbrush, are an ideal medium for these active components. They are effective in preventing plaque buildup in gingivitis if used for a long time. (3)
Self-Care and Home Remedies
1. Self-Care Tips
Here are tips that can help in the prevention of gingivitis.
- Discard your toothbrush as soon as the bristles start to give way and appear damaged. It is best to switch your old toothbrush with a new one every 3 to 4 months.
- Use a fluoride-based toothpaste. It is credited with significant antibacterial and antiseptic potential and is highly recommended by oral health experts for the prevention of gum disease.
- Regularly floss your teeth at least two times daily to remove the gunk and bacteria lodged between your gums and teeth.
- If you can, use an electric toothbrush. It has better efficiency in plaque removal.
- A water pick is a useful tool for patients with extensive dental work such as bridges and dental implants.
- You must also practice regular tongue scraping, at least once a day.
- Add an anti-bacterial mouthwash to your oral care routine to prevent plaque build-up and improve gingivitis.
A chlorhexidine gluconate mouthwash is one of the most popular dentifrice choices for inhibiting the growth of oral bacteria.Its use is associated with reduced plaque formation.
However, long-term use of chlorhexidine mouthwash may cause staining on teeth. It is also considered unsuitable for anyone below the age of 18. (4) Other safe options include eucalyptol, menthol, salicylic acid, and thymol-based mouthwash.
- Chewing crunchy fruits such as apples, carrots, and radishes can help stimulate your salivary glands to produce more saliva.The increased salivary flow can help to naturally clean your oral cavity by washing over your gums and teeth.
Cruciferous vegetables such as celery, cabbage, and kale are also helpful in this regard, besides adding to your overall nutritional intake.
- Increase your intake of calcium-rich foods that can help strengthen your dental structure.
- Eat cheese and yogurt to help control and reduce the number of bacteria in your mouth.
- Vitamin C is a powerful antioxidant that can help enhance your oral as well as overall health. You can get your required dose of this vital nutrient through your diet.
If you fail to meet your daily minimum requirement through food, you can ask your doctor about taking a vitamin C supplement.
- Harmful bacteria thrive on sugars. Needless to say, you must avoid eating high-sugar foods.
- Squishing salt water in your mouth helps to dislodge the food debris and makes it easier to remove or spit out.
Also, tepid salt water washing over the red, inflamed gums may help soothe the gingivitis-induced swelling.
- Finish your meal with some water to gulp down any food particles that may be stuck inside your mouth.
- Vitamin D reduces the risk of gum disease. You may take vitamin D supplements after consulting your doctor.
- Tobacco use in any form can severely damage your teeth and gums and should be avoided.
- You must visit your dentist at least twice a year for a thorough evaluation of your oral cavity. This regular checkup can alert you of any oral problems right at the onset and make early treatment possible.
The dentist may conduct a deep cleaning of your teeth and gums if he feels the need for it. This can help prevent any undue infections or complications later.
- Guava leaves may exhibit some degree of antioxidant, anti-inflammatory, antimicrobial, and pain-relieving properties.
These properties can be utilized to fight gingivitis and other oral health issues. You can directly chew a few guava leaves or grind them into a paste and then brush your teeth with it. (7)
- Baking soda is an alkalizing agent that can help bring down the acidity in your mouth, provided it is used properly. You can make a mouth-cleansing paste by adding a few drops of warm water to a small amount of baking soda.
Apply it on the swollen gums for a few minutes. As baking soda is a natural antiseptic, this topical therapy may help reduce the risk of tooth decay, gum disease, and oral infections. (5)
- Miswak is a pencil-thin teeth cleaning tool that is made from the twigs, stem, and roots of the Arak tree (Salvadora persica).
This natural toothbrush is credited with significant antibacterial, antifungal, antiviral, antioxidant, analgesic, anti-inflammatory, anti-cariogenic, and antiplaque properties.
Chewing on this stick not only enhances salivary flow but also releases certain substances that favorably alter the salivary composition almost instantly.
Thus, miswak may help make your oral environment less conducive for the growth of bacteria and dental demineralization.In fact, some studies suggested that the mechanical and chemical cleansing action of miswak may be as effective as, or sometimes even supersede, that of the toothbrush. (8)(9)
- Scientific evidence suggested that topical application or chewing of honey may help reduce the risk of gingivitis and caries in people undergoing orthodontic treatment. (10)
- According to one study, oxygenating mouthwashes containing hydrogen peroxide may help reduce the redness in your gums caused by gingivitis when used as a long-term adjunct to daily oral hygiene. (11)
The pharmacological virtues of turmeric are attributed to its main active component called curcumin.
This yellow-colored compound packs a lot of antioxidant, astringent, and antimicrobial properties.
These properties can be utilized in the treatment, management, and prevention of periodontal diseases such as gingivitis.
Curcumin may help promote your oral health by curbing bacterial activity and the resultant plaque formation.
By improving your plaque scores, this therapeutic agent may help decrease the gingival pain, swelling, and bleeding associated with gingivitis.
A 2012 randomized controlled trial conducted on 60 subjects with mild to moderate gingivitis found turmeric mouthwash to exhibit similar antiplaque, anti-inflammatory, and antimicrobial properties as the commonly used chlorhexidine gluconate mouthwash. (6)(12)
Turmeric dentifrices may help in treating gingivitis when used in conjunction with other oral hygiene measures. In fact, a turmeric mouthwash may be as effective as the regular chlorhexidine mouthwash in ridding your mouth of bacterial plaque. It does so without causing any negative side effects such as a bitter aftertaste and teeth staining, which are commonly associated with chlorhexidine mouthwash. Despite these merits, it is always recommended to consult your doctor before incorporating turmeric in your regular oral hygiene practices.
3. Oil Pulling
Oil pulling is an ancient oral hygiene practice that is rooted in the Ayurvedic school of medicine.
This therapy optimizes the detoxifying potential of certain oils for eliminating oral bacteria and thereby reducing plaque formation.
All you have to do is to squish a small amount of oil in your mouth for about 15-20 minutes. This is done to draw out the food particles, bacteria, and other impurities in your mouth.
Once you are done rinsing, you must spit out the oil. Ingesting the oil and impurities can raise future health concerns and is strictly ill advised.
Spit the oil in a trash can rather than a sink, as the oil can clog the drain pipe and may stain your basin.
If done regularly and properly, oil pulling may inhibit the formation of plaque and strengthen your gums, both of which can help alleviate gingivitis. (14)
Note: Do not gargle or swallow the oil.
Coconut oil is widely used in soap manufacturing due to its high saponification value. These soaps lather well and hence engender a greater cleansing action.
When coconut oil is used in oil pulling, the lauric acid in it reacts with the sodium hydroxide in the saliva to form sodium laureate, a substance found in most soaps.
The same mechanism could be in action in oil pulling, which reduces the plaque buildup and cleanses the teeth.
According to a 2015 study published in the Journal of Nigeria Medical Association, coconut oil is an easy, safe, and fairly inexpensive agent for oil pulling. (20)
It has minimal side effects and hence can be used as an adjunctive agent to preserve your oral health.
Sesame oil and sunflower oil can also help reduce plaque-induced gingivitis. However, coconut oil is more easily available. (20)
The antiplaque effect of oil pulling was demonstrated by a 2017 randomized controlled study conducted on 40 dental students.
The findings gave credence to the claim that this adjunctive oral care measure may be useful in treating plaque-induced gingivitis by curbing the growth of oral bacteria. (13)
Oil pulling can be a beneficial adjunctive therapy for the prevention and treatment of gingivitis, provided that you do it properly. You must ask your dentist to explain the basics of this technique and any precautions that may go with it. To avoid any undue reactions, it is advised not to attempt this procedure without consulting your dentist first.
4. Aloe Vera
Aloe vera possesses antibacterial properties, so it can help prevent plaque buildup that leads to gingivitis. It combats the bacteria responsible for periodontal disease.
It also decreases the swelling of the gums, hence relieving the pain and reducing gum bleeding.
A 2016 study published in the Journal of Clinical and Experimental Dentistry concluded that an aloe vera mouthwash is as efficient as chlorhexidine in lowering plaque accumulation and treating gingivitis.
The vitamin C content of aloe vera helps in the production of collagen and vasodilation. These processes, in turn, increase the oxygen concentration at the site of the injury. (24)
Another 2014 randomized controlled trial conducted on a total of 300 healthy participants found aloe vera mouthwash to be as effective as the standard variety chlorhexidine mouthwash in reducing dental plaque, without engendering any adverse side effects. (16)(17)
Note that the clinical effectiveness of aloe vera as an oral hygiene agent is not completely unsubstantiated. More extensive and rigorous studies are needed to conclusively establish these claims. (15)
Aloe vera possesses considerable healing properties that can be utilized in the preservation of your oral health. The use of aloe vera-based oral hygiene products has shown some promise in the treatment and prevention of gingivitis, with negligible side effects.
However, before you incorporate this ingredient in your oral hygiene regimen, run your decision by your dentist first. Anyone who is allergic to aloe vera should refrain from using dentifrices that contain it.
5. Herbal Rinse
Certain herbs including clove, tea tree, and basil may inhibit the growth of oral bacteria and plaque formation. Hence, they can help protect your oral cavity from gingivitis and other oral diseases.
Rinsing your mouth with a herbal mouthwash that contains such protective agents may offer a comprehensive and long-lasting disinfecting effect.
According to a double-blind, randomized controlled clinical trial, the antiplaque, antigingivitic, and antimicrobial efficacy of a herbal mouth rinse can be maximized by making it part of your oral hygiene routine. (21)
A 2015 clinical study conducted on 100 subjects with mild to moderate gingivitis favored the use of a herbal mouthwash containing cardamom, peppermint oil, carom seeds, Indian wintergreen, piper betel, and beleric in conjunction with mechanical therapy to inhibit plaque accumulation and reduce the intensity of gingivitis symptoms. (22)(18)
Another 2016 study found Triphala-containing mouthwashes to be effective in reducing the gingival inflammation and bleeding brought on by gingivitis. (19)
Lemongrass mouthwash may also serve as a safe and effective therapeutic agent that can help address gingivitis symptoms, including bad breath.
The antimicrobial and anti-inflammatory properties of tea tree oil can also be utilized for the inhibition of plaque buildup. Tea tree oil may help reduce gum swelling and improve various other indices of oral hygiene.
According to a 2019 study published in the Journal of the European Academy of Pediatric Dentistry, tea tree oil when used as part of a mouth rinse may help in the management of gingivitis symptoms. (29)(23)
When using a mouthwash containing tea tree, be sure to spit out the solution after rinsing your mouth with it.
Extra precaution is needed to keep yourself from swallowing this potent liquid as it can cause stomach irritation once ingested. It may even trigger diarrhea.
Conclusion: A herbal mouthwash can enhance your oral health on several counts when used in combination with other oral hygiene measures. This form of supportive care may be especially helpful for people with gingivitis or gum swelling. Given there are so many options to choose from, your dentist can recommend the most suitable herbal mouthwash for your particular case and the appropriate way to use it.
How Should You Brush?
Brushing your teeth twice a day is the most foundational step of any oral hygiene regimen.
If done correctly, this mechanical method can remove the food particles and plaque layers that get accumulated on your teeth, gums, and tongue.
Here are a few guidelines to help you master the brushing technique:
- You cannot perfect the brushing technique unless you have the correct toothbrush for it.
A soft-bristled toothbrush provides a gentle abrasive action that can clean the teeth and gums thoroughly without damaging their structural integrity.
- You must avoid the common mistake of brushing your teeth at a right angle. The correct position is to hold the bristles at a 45° angle against the gumline.
- Instead of scrubbing rigorously, use small circular strokes and gentle but firm pressure while brushing the outer enamel of each tooth.
- Brush the external surface of the teeth several times, keeping the bristles angled at 45° against the gumline.
- Repeat the same circular sweeping action on the inside surfaces of all your teeth.
- Use light vertical strokes to clean the insides of your front teeth.
- Make sure to clean the biting and grinding surfaces of your lower and upper teeth.
- Cleaning your tongue is just as important as brushing your teeth and gums.
However, a lot of people make the mistake of overlooking this crucial aspect of oral hygiene.The food debris and the bacteria it breeds often settle on the tongue, forming a film of plaque that can make your mouth smell.
Over time, this kind of bacterial growth in the mouth can invite serious periodontal problems.So, it is essential to brush your tongue to scrape off the food and bacterial accumulation on top of it.
Is Gingivitis Contagious?
Gingivitis is essentially an inflammatory response of the body to the bacterial plaque settled under the gums, wherein the gingival tissue swells up and appears red.
While this inflammatory response by itself is not contagious, the bacteria responsible for it can be spread through salivary exchange.
So, it is best not to eat from the same utensil as someone with periodontal disease. You must not share oral health equipment with anyone who may show signs of gingivitis to avoid the risk of contamination.
Moreover, if you suspect that your spouse or a family member may have gingivitis or any periodontal problem, take the concerned individual for an oral checkup at the earliest.
You can tell if a person has gingivitis if he/she exhibits the following symptoms:
- Gums that are ultra-sensitive and begin to bleed easily and frequently
- Gums that appear unusually red and swollen
- Bad breath
Gum disease that develops into periodontitis may lead to complications if left untreated.
These complications include:
- Repeated formation of painful pockets of pus or gum abscesses
- Recession of your gumline due to prolonged damage to the gingival tissue
- Long-term corrosion of the tooth enamel due to the action of the oral bacteria, weakening the tooth significantly as time passes
- Buildup of plaque on and around the tooth, which can severely damage the periodontal ligament that connects the tooth to the socket
- Bacteria infiltrating the gums and reaching the underlying alveolar bone that holds the tooth in its place, progressively weakening the skeletal foundation of the tooth.
In rare cases, a poorly handled case of gingivitis can escalate to a painful bacterial infection known as trench mouth.
Your oral cavity is naturally populated with a variety of bacteria that exist in perfect equilibrium. This state of balance is disrupted whenever there is an excess of any particular strain, paving the way for oral disease.
Such bacterial overgrowth if left unchecked can infect your gums and cause swelling. The gingival inflammation is often accompanied by the development of painful ulcers.
The infection can gradually encompass your entire gingival lining and the underlying alveolar bone that contains the sockets of your teeth.
This extreme form of gingivitis goes by several names, including trench mouth, Vincent angina, or acute necrotizing ulcerative gingivitis. This condition can lead to the following complications:
- Your entire gum line may be damaged severely.
- You may develop large, gaping sores, or ulcers, which can permanently puncture the affected gums.
- Your teeth may become increasingly loose and unstable.
Some factors can make you susceptible to gingivitis. These include:
- Crooked teeth that are difficult to clean
- Excessive use of tobacco
- Genetic factors
- Low nutritional levels
- Taking certain medicinal drugs, such as antidepressants, heart ailment drugs, and birth control pills
- Hormonal fluctuations associated with pregnancy and the menstrual cycle and the use of oral contraceptive pills
- Old age
- Poor oral hygiene
When to See a Doctor
The above-mentioned remedies are helpful in treating gingivitis to a considerable extent. However, medical assistance must be sought if the condition becomes severe and unmanageable.
Consult your doctor if:
- You feel a lot of pain and discomfort.
- Your symptoms do not get better.
- You have red, swollen gums, especially if you have not had a dental checkup and tooth cleaning in the last 6 months.
What you may want to ask your doctor:
- Can my condition be resolved with regular brushing and flossing?
- How regularly should I see my dentist?
- What are the implications of my oral health on my overall health?
- Do home remedies actually work for gingivitis?
- Does poor oral health have long-term effects on overall health?
- Do these medicines have any side effects?
- What are the complications associated with gingivitis?
- What is the proper way to brush my teeth?
What your doctor may ask you:
- What are your brushing habits?
- What does your daily diet look like?
- Are you a smoker?
- How often you go to the dentist?
- Are any of your family members also affected by gingivitis?
Maintenance of oral hygiene is always necessary, whether you have a disease or not. However, it becomes imperative to keep your teeth and gums clean if you have a dental problem.
So, do not ignore any discomfort you may have in your oral cavities. Get proper treatment as soon as possible.
Expert Answers (Q&A)
Answered by Dr. Wessam Atteya, BDS, FRACDS (Dentist)
Yes. It is indeed, however all the contributing factors need to be controlled.
Gingivitis is an inflammatory condition in which the gingiva (gum/soft tissue around teeth necks) is inflamed, but when this inflammation reaches the deeper tissues surrounding the teeth (ligaments and bone), it is then called periodontitis, which is commonly characterized by bone loss around the teeth.
It significantly depends on the severity of the case as well as on the control of causative factors that initiated and aggravated it.
With good oral hygiene and control of other contributing factors, gingivitis can heal rapidly within a few weeks.
Generally, causative factors are classified into primary and secondary factors. The accumulation of plaque and calculus with bacterial masses (associated with poor dental care) is the primary factor in most gingivitis cases.
Secondary factors include cavities, broken teeth/fillings, ill-fitting dental prosthesis, smoking, stress, hormonal disturbances, and medical conditions compromising the patient’s immunity.
A dentist will be able to identify the specific factor for each case, then treat it accordingly.
Untreated cases of gingivitis will progress to periodontitis in which jawbone and teeth loss will be inevitable.
The simple answer is YES, however most forms of gingivitis are not communicable, except for those caused by viruses and some bacterial infections.
No. Gingivitis must be treated by removing the causes contributing to the condition. Saltwater can help as an additional measure in very limited cases.
Preventive tips for gingivitis relief:
– Brush your teeth at least two times daily using a soft toothbrush. It is recommended to follow the Bass technique for brushing the teeth.
– Floss daily.
– Visit your dentist regularly for professional check-ups and cleaning.
– Avoid smoking.
– Control stresses and manage grinding/clenching.
– Eat healthy well-balanced foods.
Available treatment options:
– See your dentist for a proper diagnosis of the contributing factor and follow their advice.
– Follow the preventative measures mentioned above.
About Dr. Wessam Atteya, BDS: Dr. Atteya has almost 20 years of experience treating patients which he gained in public and private practices both in Melbourne and in Cairo.
He practices almost all facets of dentistry with a special interest in Implant Dentistry and Oral Surgery, as well as Cosmetic Dentistry.
Dr. Atteya worked at the Royal Dental Hospital of Melbourne and lectured for the Clinical Training Unit of the Dental Health Services of Victoria.
He is also a Mentor for the Royal Australasian College of Dental Surgeons – Sydney and serves on the Continuing Professional Development Committee of the Australian Dental Association – Victorian Branch.