Gingivitis: treating it before it becomes periodontitis

Recognising gingivitis

The signs are subtle and almost never painful: bleeding when brushing or on its own, a red gum instead of pale pink, a swollen and smooth gum margin, sometimes bad breath ^[4]. Bleeding is not “normal” and should not lead you to brush more gently or to avoid the area: the opposite is what helps.

In smokers, the gum bleeds less even though the inflammation is there: the absence of bleeding is no reassurance.

Where does it come from?

The primary cause is dental plaque, a film of bacteria that builds up every day at the neck of the teeth and between them. When it is not removed, it hardens into tartar, which holds even more plaque. Some conditions amplify the gum's reaction: pregnancy and hormonal changes, poorly controlled diabetes, certain medicines, smoking, mouth breathing, appliances or prostheses that are hard to clean, crowded teeth ^[1].

Gingivitis or periodontitis: the difference that matters

In gingivitis, the inflammation stays in the gum; the bone and the tooth's attachment are intact, and everything can return to health ^[1]. In periodontitis, the attachment and the bone are affected: the gums can recede and teeth can loosen or drift apart. Only a full periodontal examination, clinical and radiographic, can tell the two apart. Not every case of gingivitis becomes periodontitis, but every case of periodontitis started with an inflamed gum: that is why it is treated early.

The signs and diagnosis of periodontitis are covered in the article Understanding periodontitis; its treatment, on the page Periodontitis treatment.

How gingivitis is treated

1. At the practice: removal of tartar and plaque above and just below the gum margin, then polishing; spotting the areas that trap plaque (an overhanging filling, a crown, an appliance) so they can be corrected ^[2].
2. At home, every day: brushing twice a day with a soft or electric toothbrush, and cleaning between the teeth with interdental brushes sized to each space (floss where the brush does not fit). Cochrane reviews show that interdental cleaning added to toothbrushing reduces gingivitis and plaque compared with toothbrushing alone; interdental brushes seem at least as effective as floss (low certainty, according to the same review) ^[3].
3. Mouthwashes can help for a few days on prescription; they replace neither brushing nor interdental cleaning, and a chlorhexidine mouthwash stains the teeth if used for long.
4. Check-up: the gum is reviewed to make sure the bleeding has stopped. If signs persist, a full periodontal assessment looks for early periodontitis.

What has no place here

Antibiotics do not treat ordinary gingivitis. No toothpaste or supplement replaces the mechanical removal of plaque. Gingivitis is treated by removing plaque and tartar; at the practice, the laser is used in addition to periodontal treatment when periodontitis is diagnosed.

When to see a periodontist

• Bleeding that persists despite proper brushing and interdental cleaning.
• A receding gum, a loose tooth, a gap appearing between two teeth, lasting bad breath.
• Diabetes, pregnancy, smoking, a family history of receding gums and loose teeth: the gums deserve closer follow-up.

At the practice, the first consultation includes a full periodontal assessment; at this visit Dr Hazout takes a bacterial sample and, depending on your overall health, a blood test, to understand the bacterial flora and adapt the follow-up.

To prepare your visit: the first consultation and booking an appointment; for everyday care: oral hygiene: brushing techniques.

Frequently asked questions