Gingivitis
 

What is Gingivitis?

Gingivitis means swelling or inflammation of the gums. It is a very common condition that is present in most of our mouths to some extent.

Do your gums bleed when you brush? This is the classic complaint of someone who has gingivitis.


It can occur on its own, or it can be a sign that you have more serious gum disease
(periodontitis) and have irreversibly lost some of the bone that supports your teeth. It is best to see a dentist to rule this out.

Gingivitis can also lead to periodontitis, so it is important that you get it under control as quickly as possible.

How is it caused?

Gingivitis is caused by a build up of dental plaque. Our body's response to this bacteria, is to send more natural protection to the area and we do this by the process of inflammation; our blood vessels open up and our gums become swollen.


Gingivitis is mostly a chronic (long lasting) problem where a balance between our body's defences and the bacteria occurs.

If we get rid of the plaque, we tip the balance in our favour and the gingivitis will clear up; if we don't, it will stay as it is, or as I have mentioned, can potentially progress to periodontitis.

Anything that makes cleaning your mouth more difficult, such as braces or a partial denture, will make you more susceptible to getting gingivitis, because the plaque becomes harder to remove. Extra care and time spent cleaning is essential in these circumstances. If plaque is left on your teeth, it will over time calcify into calculus (tartar); this cannot be removed by brushing alone and requires a visit to the dentist and a professional clean to get you back to square one.

How do I know I have got Gingivitis?

Gingivitis has a classic appearance, so that once you have seen a few examples, it is easy to spot. In gingivitis, the gums are swollen and inflamed. They are much redder, particularly just round the margins (where the teeth and gum meet). They will probably bleed on brushing, or gentle probing at the dentist. Often the dentist can see the dental plaque which hasn't been removed or disturbed by brushing; this is responsible for the gum inflammation.

To be able see gingivitis (as in the picture), takes about 5-7 days of plaque build up. That means you have missed brushing the gums in that area for an entire WEEK! Less obvious plaque build up can be highlighted by chewing a 'disclosing tablet" which does as the name suggests, and shows up any plaque on your teeth.

But 'I brush twice a day', I hear you say- well 'not ideally' would be my reply... Time to get back to the basics of good oral hygiene.

We brush so often, that we commonly go into autopilot, which means we don't watch exactly where we are brushing, or check the technique we are using. We may be watching TV, or walking around the house while we brush, or we may be being distracted in someway- so if you have gingivitis, it is certainly time for a refresher.

What do Healthy Gums look like?

Healthy gums are firm, normally pale pink (racial pigmentation may be present) and often have a sort of 'stippled' appearance. There is no sign of swelling or any redness and the gums fill the space in-between the teeth. If we were to probe around the gum, there would be no bleeding and the probe would only go to to a depth of about 1-3mm.

In a perfect mouth no root surface would be exposed, but healthy gums can still exist, even if some root surface has been exposed. Root surface exposure is frequently a result of over brushing, that has worn away some of the gum margin, or it may be associated with true attachment loss as in periodontitis.

With the right care, even if you have suffered previous gum disease, you can have healthy gums.

Are there Different Types of Gingivitis?

So far we have being talking about the most common form of gingivitis, but there is another type which can be easily spotted- we refer to it as 'hyperplasic gingivitis'. This type of gingivitis has similar features to the common form- redness (though often not as much) and no pocketing or attachment loss - but the level of swelling is much larger and a little scary looking.

The condition is often an unwanted side effect of taking certain drugs such as phenytoin for epilepsy, cyclosporine or nifedipine are other examples. It can also be a feature of the inherited conditions of Crohn's disease or sarcoidosis, (in this case we call it hereditary gingivofibromatosis). The swelling of the gums in hyperplastic gingivitis is much tougher (more fibrous) than the normal gingivitis which has a 'squishier' feel. Because of this, the response to normal cleaning and improved oral hygiene is often less noticeable.

In some circumstances it might be that we need to cut the gums back to reveal the normal height of the teeth in a simple surgical procedure called a 'gingivectomy'.