What is gingivitis?

Simply put, gingivitis is inflammation of the gums. Gingiva refers to the gum tissue that surrounds the teeth. The “itis” means inflammation. Many things in our body can be inflamed such as; appendicitis, tonsillitis, tendonitis, bursitis, etc.

In this case, gingivitis is inflammation of the gums; this inflammation is caused by the body’s response to bacteria which is in the mouth. The mouth naturally has millions of bacteria present at any given time, some of the bacteria being harmful and some not. The problem starts most of the time when overgrowth of bacteria starts to occur due insufficient homecare and professional dental care. Other factors can also come into play which may allow a person to develop gingivitis.

In simple bacteria-related gingivitis, build-up of bacteria accumulates around and on the teeth. The bacteria are attached to a tooth via what is called “dental plaque”. Plaque simply put is a matrix of food, bacteria and other particles which adhere to the tooth. When plaque is not cleaned away it starts to irritate the gum, which in turn, signals the body to initiate an inflammatory response. The body puts up a fight against the bacteria to prevent disease; this is when you may see bleeding and redness. The body attempts to bring blood cells to the site of the inflammation to help heal what it perceives as bacterial invasion; in this case, bacteria within the plaque is the invader. Bleeding should not be perceived as something to be afraid of, it is simply the body’s way of telling the person something is wrong and to do something about it. This is when I recommend to floss and brush more, not less.

In other cases of gingivitis, the body’s response can play a role in how it responds to dental plaque. Sometimes due to hormonal fluctuations in women, whether it is during pregnancy, cyclical changes during the menstrual cycle or peri-menopausal, a woman’s mouth can be very sensitive to the dental plaque that is present and can develop hormone-induced gingivitis very easily. As well, people who are diabetic, have other systemic diseases and take medications can be at higher risk for developing gingivitis.

Overall, the most important thing you can do at home for preventing and help treat gingivitis at home is:

• Brush 3 times a day for 2 minutes with an electric toothbrush.
• Floss daily, making sure to clean well below the gum line.
• Mouth rinses, such as Listerine, which can help kill the bacteria that cause gingivitis or saltwater rinse (a teaspoon of salt in a cup of water).
• In between meals if you are not able to brush, drink water, or chew sugar-free gum for a few minutes to help loosen food and wash it away.

Most adults are aware of the old adage to see your dentist every 6 months for a cleaning and check-up. Research has shown us that it takes about 3 months for bacterial plaque to mature, this is called biofilm and we all have some of this on our teeth, usually below the gum line. For some people who have healthy mouths, that biofilm will cause no harm. For a large part of the population who have gingivitis, i.e. gums that are red and bleed, 6 months between cleanings may be too long and damage to the gums and underlying structures may occur. For many gingivitis patients I recommend 3-4 month dental therapy appointments so we can remove the harmful biofilm to prevent progression of disease.

Many patients I see brush very well (some a little too well!) but forget the flossing. My line is, “floss the teeth you want to keep!”