Gingivitis: Reversing and preventing early gum disease

Gingivitis is a common form of periodontal disease, also called gum disease. Left untreated, it can lead to periodontitis, a more serious condition. Fortunately, there are simple ways to reverse and prevent gingivitis.

What is gingivitis?

Gingivitis is a type of gum disease in which the tissue at the base of your teeth, called gingival tissue, becomes inflamed, or swollen. The most common form of gingivitis happens when food particles and other substances build up around your teeth, causing sticky plaque and hard tartar to form at and below your gums.

In the early stage, this buildup isn't harmful if home care and regular dental cleanings can keep the inflammation in check, explains Dr. Tien Jiang, assistant professor in oral health policy and epidemiology at the Harvard School of Dental Medicine. However, ongoing inflammation from gingivitis can lead to an irreversible form of gum disease called periodontitis, she says, which can damage the tissues and bones that support your teeth. (Dental x-rays may be needed to see if the inflammation from gum disease has become periodontitis.)

In addition, studies have shown that having gum disease can put you at higher risk for heart attack, stroke, and dementia.

Symptoms of gingivitis

In the early stages, gingivitis usually doesn't cause discomfort. As gum disease progresses, gingivitis symptoms can include:

• red, sensitive, or swollen gums
• gums that bleed when you brush or floss your teeth
• bad breath (halitosis)
• mouth sores.

What causes gingivitis?

Most gingivitis begins with plaque (which is also a major cause of tooth decay) that hardens into tartar. A buildup of plaque and tartar at the gumline, along with bacteria that are normally present in your mouth, can irritate and inflame your gums, causing gingivitis.

Certain things can put you at higher risk for gingivitis, including:

• poor dental hygiene
• smoking
• pregnancy, when hormonal changes make your gums more sensitive
• diabetes that isn't well controlled
• certain infections elsewhere in your body
• misaligned teeth
• unclean mouth appliances such as braces or dentures
• certain medicines.

Treating gingivitis at the dentist

Regular cleanings from a dentist or dental hygienist can remove plaque deposits before gingivitis causes more serious problems. The dental team has special tools that can be used to scrape under the gumline.

If your gums are sensitive after cleanings, Dr. Jiang suggests rinsing your mouth with warm water mixed with table salt twice a day, taking acetaminophen or ibuprofen (as long as your medical conditions permit taking these pain relievers), or both. "If the gingivitis was extensive, you may need to allow up to two weeks for the tissues in your mouth to recover," she adds.

You can ask your dentist to go over toothbrushing techniques with you, as well as whether you could benefit from an electric toothbrush, a special toothpick, or a water flosser.

Reversing and preventing gingivitis at home

Brushing teeth at least twice a day, and flossing at least once a day, can help reverse and prevent gingivitis. Dr. Jiang recommends brushing in front of mirror in a bathroom with good lighting. She suggests pulling back your lips to look in a mirror for plaque at the gumline, or feeling with your tongue after brushing to search for rough areas of plaque. If you spot remaining plaque, angle your toothbrush to better reach those areas. If you repeatedly miss certain areas, try replacing your toothbrush head. Often, a smaller toothbrush head can do a better job getting to hard-to-reach areas.

Your dentist also may recommend anti-plaque or anti-tartar toothpastes or mouth rinses.

As people age, they may lose some dexterity that can affect how well they brush their teeth, so seniors in particular (and their caregivers) should pay attention to good toothbrushing techniques.

Dr. Jiang says that plaque rinses or tablets, available over the counter, stick to plaque and turn it a bright color, to help you identify areas where plaque is building up and where toothbrushing is especially needed.

"Most people do a good job removing plaque from the smooth or chewing surfaces of their teeth," Dr. Jiang says, "but you need to pay attention to other places where plaque sticks, such as the gumline or between teeth, in order to avoid gingivitis."