Gingivitis: Symptoms, Causes, Treatment and Prevention

Gingivitis is the earliest and mildest form of gum disease. It commonly causes red, swollen or bleeding gums because plaque has accumulated around the gumline. Gingivitis does not involve the bone loss seen in periodontitis and is usually reversible with effective daily cleaning and professional dental care.

Reviewed by Dr. Manish Pandey, BDS. This article provides general education and does not replace a dental examination.

What is gingivitis?

Gingivitis means inflammation of the gingiva—the gum tissue surrounding the teeth. Healthy gums are generally firm and do not routinely bleed during gentle brushing or interdental cleaning. In gingivitis, the gum margin may become red, puffy, tender or prone to bleeding.

The condition can affect a small area or much of the mouth. It may cause little or no pain, so bleeding is often the first sign a person notices. Bleeding gums should not be ignored or accepted as normal.

Gingivitis versus periodontitis

The previous version of this article listed loose teeth, pus, root planing and gum surgery as features of gingivitis. Those findings suggest more advanced periodontal disease or another problem, not uncomplicated gingivitis, and require professional evaluation.

What causes gingivitis?

The most common cause is plaque-induced inflammation. Plaque is a soft, sticky biofilm that forms continuously on teeth. When it remains along the gumline, the body’s inflammatory response makes the gums swell and bleed. Plaque that is not removed can harden into tartar or calculus, which cannot be brushed away at home and requires professional removal.

Food does not simply “pool” inside a healthy gum sulcus as the old article stated. The central issue is persistent bacterial plaque at and below the gum margin. Crowded teeth, rough restorations, braces and appliances can make plaque removal harder, but they do not replace plaque as the usual initiating factor.

Signs and symptoms

• Bleeding while brushing, flossing or eating firm foods
• Red, darker or swollen gums
• Tenderness at the gumline
• Shiny or puffy gum margins
• Persistent bad breath or an unpleasant taste
• Plaque or tartar visible around the teeth

Gingivitis can be painless. By contrast, gum recession, deep pockets, loose teeth, pus, painful chewing or a change in the bite may indicate periodontitis, an abscess or another condition. Arrange a dental assessment rather than trying to diagnose the stage yourself.

Risk factors

• Ineffective plaque removal: inconsistent brushing or failure to clean between teeth
• Smoking or other tobacco use: increases periodontal risk and may make bleeding less obvious
• Diabetes: especially when blood glucose is poorly controlled
• Hormonal changes: including puberty, pregnancy and menopause
• Dry mouth: from medical conditions, medicines or reduced saliva
• Crowded teeth and appliances: areas that are difficult to clean
• Certain medicines or systemic conditions: some can alter gum tissue or immune response
• Genetic susceptibility, stress and nutrition: may modify a person’s overall risk

Risk does not guarantee disease. It indicates that cleaning technique and dental monitoring may need to be tailored to the individual.

How dentists diagnose gingivitis

A dentist or dental hygienist examines the colour, contour and bleeding of the gums and checks for plaque and tartar. A small periodontal probe measures the spaces around teeth. Medical history, smoking, medicines, pregnancy and diabetes may affect the assessment. Dental X-rays may be recommended when bone loss or other disease is suspected; gingivitis itself does not produce periodontal bone loss.

Treatment

Professional cleaning

A professional cleaning removes plaque, tartar and deposits that home brushing cannot remove. Your clinician can identify sites you are missing and demonstrate a brush, floss or interdental-brush technique suited to your mouth. Routine scaling for gingivitis is different from the deeper periodontal treatment used when periodontitis is present.

Daily plaque control

• Brush twice daily with fluoride toothpaste using gentle pressure at the gumline.
• Clean between teeth every day using floss or appropriately sized interdental brushes.
• Follow the technique advised by your dental professional around crowns, bridges, implants or braces.
• Clean the tongue if coating contributes to bad breath.
• Replace a worn toothbrush or brush head.

Bleeding may initially continue when inflamed areas are cleaned. Do not scrub aggressively, but do not avoid the area. Ask a dental professional to check your technique if bleeding persists.

Mouthwash and medicines

Mouthwash does not replace brushing or interdental cleaning. A dentist may recommend a short course of an antiseptic rinse such as chlorhexidine in selected situations, but it can stain teeth, change taste and interact with toothpaste timing. Doxycycline is not an “antibiotic mouthwash” for routine gingivitis, contrary to the old article. Do not self-start antibiotics; ordinary plaque-induced gingivitis is managed by removing plaque and improving daily care.

Is surgery needed?

No—surgery is not standard treatment for uncomplicated gingivitis. Procedures such as flap surgery or grafting are reserved for specific periodontal problems diagnosed after examination. If advanced disease is present, a dentist may refer you to a periodontist.

How long does gingivitis take to improve?

Bleeding and swelling may begin improving after effective plaque removal, but the time varies with severity, tartar deposits, technique and risk factors. Improvement should be confirmed at follow-up. Persistent bleeding may mean plaque remains, tartar needs professional removal, or another condition is present.

When to see a dentist

Book a dental examination if your gums bleed repeatedly, remain swollen or painful, or you have persistent bad breath. Seek an urgent dental appointment for very painful or rapidly worsening swelling, loose teeth, pus, ulcers or red patches, a mouth lump, facial swelling, fever or difficulty opening the mouth. Difficulty breathing or swallowing with facial or neck swelling requires emergency medical help.

Prevention

• Brush twice daily with fluoride toothpaste; spit rather than immediately rinsing it away.
• Clean between every tooth daily. See how to use dental floss.
• Attend dental check-ups at an interval based on your risk.
• Do not smoke; ask a healthcare professional for quitting support.
• Manage diabetes with your medical team.
• Have rough, broken or difficult-to-clean restorations assessed.
• Ask for pregnancy-specific oral-health advice if your gums change.

Frequently asked questions

Is gingivitis contagious?

Gingivitis is not usually described as a contagious disease. Oral bacteria can be shared, but disease depends on plaque accumulation, the person’s immune response and other risk factors.

Can gingivitis cause loose teeth?

Uncomplicated gingivitis does not destroy supporting bone. Loose teeth suggest periodontitis, trauma or another problem and should be assessed promptly.

Can gingivitis be reversed?

Yes, plaque-induced gingivitis is generally reversible when plaque and tartar are controlled and contributing factors are addressed. Periodontitis-related bone loss is different and is not fully reversible.

Clinical references

• National Institute of Dental and Craniofacial Research: Gum disease
• CDC: Periodontal disease
• NHS: Gum disease