Periodontology – Gingivitis

Gingivitis is classified as a non-destructive disease which causes gum inflammation. The most common form of gingivitis is caused by a response to bacterial biofilms or plaque attached to surface of the teeth. In most cases of gingivitis, the cause is linked to plaque. While not all cases of gingivitis progress into periodontitis, gingivitis always occurs before periodontitis.

Gingivitis can be reversed through an improved oral hygiene routine. When it remains untreated, however, it can result in more serious periodontitis. In periodontitis, the chronic inflammation of the gums causes destruction of the tissue and bone resorption occurs around the teeth. In the most severe cases, periodontitis can result in the loss of teeth.

Signs & Symptoms

Below are some of the most common signs and symptoms of gingivitis:

  • Bad breath or halitosis
  • Bleeding gums, which occurs after brushing or flossing
  • Bright red or purple gums
  • Swollen gums
  • Tender gums

In addition, the stippling which typically exists in the gum tissue, often disappears. The gums may also have a shiny appearance as the gum tissue becomes swollen and stretched over the inflamed underlying connective tissue. This may also result in a foul odor. When the gums are swollen, the epithelial lining of the gingival crevice becomes ulcerated. This can cause the gums to easily bleed, even from something as simple as gentle brushing or flossing.

Below are complications associated with gingivitis:

  • Association with premature birth and lower birth weight in infants
  • Future cases of gingivitis
  • Infection or abscess of the gingiva or the jaw bones
  • Periodontitis
  • Swollen lymph nodes
  • Trench mouth

Alzheimer's and Dementia

In 2018, a new study found profound evidence that there was a possible association between gingivitis bacteria and Alzheimer's disease. Scientists agree, however, that additional research is needed in order to determine a cause and effect association. The bacteria, P. gingivalis, which is commonly responsible for various forms of gum disease, is able to migrate from where it began in the mouth to the brain in mice. Once P. gingivalis is in the brain, it is able replicate features of Alzheimer’s disease.


Gingivitis is caused by bacterial plaque, which acts to initiate the host response in the body. This response can result in gingival tissue destruction which can also progress to the destruction of the periodontal attachment apparatus. The plaque is able to accumulate within the small gaps which exist between teeth. It can also accumulate in the gingival grooves and in other areas which are called plaque traps. Plaque traps may include bulky and overhanging restorative margins, clasps of removable partial dentures and tartar which is able to form on the teeth over a period of time. While these accumulations are relatively small, the bacteria is able to produce chemicals which triggers an inflammatory response in the gum tissue. This inflammation results in the enlargement of the gingiva and subsequent formation.

Risk factors

Below are some of the most common risk factors associated with gingivitis:

  • Age
  • Aggressive oral hygiene practices or brushing with stiff bristles
  • Genetic factors
  • Inadequate dental care
  • Medications or conditions which cause a dry mouth
  • Mental health issues; including depression
  • Mouth-breathing during sleep
  • Osteoporosis
  • Pre-existing conditions such as diabetes
  • Poor oral hygiene and neglect
  • Smoking
  • Stress


Gingivitis is a form of periodontal disease which often includes inflammation and bleeding, but does not include bone loss. Each tooth contains four gingival units including mesial, distal, buccal and lingual. The teeth are then assessed a score which will ranges from 0-3 based on their gingival index. The average of the four scores is then used to assign the tooth with a single score. A dentist is required to diagnosis gingivitis and the diagnosis is based on clinical assessment data which is obtained during a comprehensive periodontal exam.