Do your gums bleed when you brush your teeth? Or do your gums appear soft or swollen? Most of us have experienced gum problems at one point or another. One of the most common gum problems is ‘gingivitis’ or inflammation of the gums.
Gingivitis is an inflammation that occurs due to a bacterial infection. In general, this inflammation occurs in the soft tissue of the gingival epithelium. The presence of metabolic products and toxins from pathogenic bacteria that accumulate in oral plaque often starts the inflammation occurring in gingivitis.
Edema and erythema (redness) are the most common clinical manifestations of plaque-associated gingivitis. Reports suggest that gingivitis triggers periodontitis. Some common symptoms are:
- Soft or spongy gums
- Receding gums
- Bad breath
- Bleeding gums
- Tooth pain/sensitivity
- Loose gums
Causes and risk factors
Several risk factors can cause gingivitis. Plaque is considered the most common trigger of gingivitis. Poor oral and dental hygiene will cause a thin layer on the surface of the teeth. When cleaning is not optimal, it allows plaque to harden, and the plaque forms calculus when hardened. This plaque contains a variety of bacteria that can cause infection and inflammation of the gingival tissue.
The main cause of gingivitis is the accumulation of microbial plaque in the gingival sulcus tissue. Several microbial species such as Actinomyces, Fusobacterium, Streptococcus, and Treponema are most commonly found in patients with gingivitis. Periodontal disease caused by these bacteria needs to be treated promptly as it can trigger other systemic diseases such as Alzheimer’s, inflammatory bowel, and oral cancer.
Hormones can also trigger gingivitis. Increased estrogen levels during pregnancy can increase the severity of inflammation in the gingival tissue. This is due to the tendency for blood vessels to dilate so that inflammatory conditions can occur excessively.
Hormonal changes during adolescence can also cause gingivitis. This is known as pubertal gingivitis. Estrogen and testosterone receptors are found in the cytoplasm of the gingival cells. This fact indicates that along with the increase in hormones during puberty, the risk of developing gingivitis is also higher. Therefore, gingivitis often appears at puberty.
Poor oral and dental hygiene is a major risk factor for gingivitis. Furthermore, gingivitis can also be triggered by systemic side effects of various drugs such as calcium channel blockers, oral contraceptives, fibrinolytic agents, anticoagulants, and phenytoin.
These drugs can induce fibroblast proliferation, thereby causing an imbalance between the degradation and synthesis of the extracellular matrix. It causes the buildup of immature proteins such as collagen in the matrix. These interactions can cause gingivitis.
Recent studies have also shown that periodontitis, a chronic inflammatory condition of the gums and mouth, is a common symptom in patients with severe COVID-19. Researchers have hypothesized that due to the microbes in the mouth, angiotensin-converting enzyme 2 (ACE2) expression increased and increased cytokines in the lower respiratory tract. This ultimately results in severe COVID-19 disease.
Gingivitis can be prevented through several approaches. Dental and oral hygiene is important to prevent gingivitis. Brushing your teeth regularly can reduce your risk of developing gingivitis by reducing the buildup of bacterial plaque on your teeth.
Flossing can be done after you brush your teeth to help clean food particles and bacteria in your mouth and between your teeth. Use of oral rinse or mouthwash twice a day further inhibits the growth of bacteria. Plaque on the teeth should also be controlled and cleaned comprehensively by the dentist every six months.
Patients with dry mouth conditions and taking medication require more regular professional dental plaque removal to prevent gingivitis. Minimizing the consumption of sugar-rich foods can also be done to prevent the growth of bacteria in the teeth and mouth. It prevents infection in the teeth due to the accumulation of plaque.
Furthermore, regular stannous fluoride (SnF2) toothpaste can effectively prevent the formation of dental plaque, dental calculus, and gingivitis. The combination of triclosan and SnF2 provides a more effective anti-inflammatory effect than conventional toothpaste. These products can improve gum health and reduce gingivitis by significantly reducing the amount of plaque on the teeth.
Gingivitis treatment aims to reduce the inflammation that occurs in the gingival tissue. In its early progression, gingivitis is easier to control through medical interventions such as professional dental plaque and calculus removal by a dentist. Scaling and root planning can be performed based on the severity of gingivitis.
Adjunctive treatment for gingival health can be done by administering an antiseptic mouth rinse containing chlorhexidine. In particular, it can help improve drug-induced gingivitis. This mouth rinse can help prevent plaque buildup and bacterial infections in the oral cavity. Regular brushing and chlorhexidine mouth rinse can prevent biofilm formation on teeth. Gingivitis improves after four to six weeks of chlorhexidine mouth rinse.
Additionally, the treatment of gingivitis can also be done by consuming herbs or medicinal plants. Research has shown that plaque index, bleeding index, microbial count, biomarkers, and degree of inflammation decreased significantly in aloe vera, green tea, miswak, pomegranate, and polyherbal formulations.
These plant-based products have phytochemical compounds with strong anti-inflammatory properties, such as flavonoids and tannins. There is a significant reduction in plaque formation, inflammation, and bacterial infection when these medicinal herbs are consumed regularly. Several studies have also shown a synergistic effect of medicinal plants on medical interventions to remove plaque on the teeth. Thus, it can prevent the onset of gingivitis.
Gum diseases such as gingivitis can hurt oral health and overall systemic health. It is, therefore, crucial to prevent gingivitis or treat it soon if it occurs. Talk to your dentist and care team today to ensure your gums stay healthy.
N. Ajmera, A. Chatterjee, and V. Goyal, 'Aloe Vera: Its Effect on Gingivitis,' J Indian Soc Periodontol, 17 (2013), 435-8.
T. R. Chaitra, N. Manuja, A. A. Sinha, and A. U. Kulkarni, 'Hormonal Effect on Gingiva: Pubertal Gingivitis', BMJ Case Rep, 2012 (2012).
I. L. Chapple, F. Van der Weijden, C. Doerfer, D. Herrera, L. Shapira, D. Polak, P. Madianos, A. Louropoulou, E. Machtei, N. Donos, H. Greenwell, A. J. Van Winkelhoff, B. Eren Kuru, N. Arweiler, W. Teughels, M. Aimetti, A. Molina, E. Montero, and F. Graziani, 'Primary Prevention of Periodontitis: Managing Gingivitis', J Clin Periodontol, 42 Suppl 16 (2015), S71-6.
P. James, H. V. Worthington, C. Parnell, M. Harding, T. Lamont, A. Cheung, H. Whelton, and P. Riley, 'Chlorhexidine Mouthrinse as an Adjunctive Treatment for Gingival Health', Cochrane Database Syst Rev, 3 (2017), Cd008676.
A. Johannsen, C. G. Emilson, G. Johannsen, K. Konradsson, P. Lingström, and P. Ramberg, 'Effects of Stabilized Stannous Fluoride Dentifrice on Dental Calculus, Dental Plaque, Gingivitis, Halitosis and Stain: A Systematic Review', Heliyon, 5 (2019), e02850.
J. T. Marchesan, M. S. Girnary, K. Moss, E. T. Monaghan, G. J. Egnatz, Y. Jiao, S. Zhang, J. Beck, and K. V. Swanson, 'Role of Inflammasomes in the Pathogenesis of Periodontal Disease and Therapeutics', Periodontol 2000, 82 (2020), 93-114.
M. Rathee, and P. Jain, 'Gingivitis', in Statpearls (Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC., 2022).
H. Safiaghdam, V. Oveissi, R. Bahramsoltani, M. H. Farzaei, and R. Rahimi, 'Medicinal Plants for Gingivitis: A Review of Clinical Trials', Iran J Basic Med Sci, 21 (2018), 978-91.
Lea M. Sedghi, Margot Bacino, and Yvonne Lorraine Kapila, 'Periodontal Disease: The Good, the Bad, and the Unknown', Frontiers in Cellular and Infection Microbiology, 11 (2021).
R. A. Togoo, B. Al-Almai, F. Al-Hamdi, S. H. Huaylah, M. Althobati, and S. Alqarni, 'Knowledge of Pregnant Women About Pregnancy Gingivitis and Children Oral Health', Eur J Dent, 13 (2019), 261-70.
S. Tungare, and A. G. Paranjpe, 'Drug Induced Gingival Overgrowth', in Statpearls (Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC., 2022).
Samuel R. Zwetchkenbaum, and L Susan Taichman, 'Chapter 14 – Oral Health*', (2008).