File:Gingivitis (crop).jpg
A case of gingivitis
Classification and external resources
ICD-10 K05.0-K05.1
ICD-9 523.0-523.1
DiseasesDB 34517
MedlinePlus 001056
NCI Gingivitis
Patient UK Gingivitis
MeSH D005891

Gingivitis ("inflammation of the gum tissue") is a non-destructive periodontal disease.[1] The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) adherent to tooth surfaces, termed plaque-induced gingivitis. Gingivitis is reversible with good oral hygiene. However, in the absence of treatment, or if not controlled, gingivitis can progress to periodontitis, where the inflammation results in tissue destruction and alveolar bone resorption, which can ultimately lead to tooth loss.[2]

While in some sites or individuals gingivitis never progresses to periodontitis,[3] data indicate that periodontitis is always preceded by gingivitis.[4]

Signs and symptoms


  • Swollen gums
  • Bright red or purple gums
  • Gums that are tender or painful to the touch
  • Bleeding gums or bleeding after brushing and/or flossing
  • Bad breath (halitosis)


Risk factors

Risk factors associated with gingivitis are:

  • low dental care utilization
  • poor oral hygiene levels
  • smoking
  • psychosocial stress and genetic factors
  • pre-existing conditions


Because plaque-induced gingivitis is by far the most common form of gingival diseases, the following sections will deal primarily with this condition.

The etiology, or cause, of plaque-induced gingivitis is bacterial plaque, which acts to initiate the body's host response. This, in turn, can lead to destruction of the gingival tissues, which may progress to destruction of the periodontal attachment apparatus.[5] The plaque accumulates in the small gaps between teeth, in the gingival grooves and in areas known as plaque traps: locations that serve to accumulate and maintain plaque. Examples of plaque traps include bulky and overhanging restorative margins, claps of removable partial dentures and calculus (tartar) that forms on teeth. Although these accumulations may be tiny, the bacteria in them produce chemicals, such as degrative enzymes, and toxins, such as lipopolysaccharide (LPS, otherwise known as endotoxin) or lipoteichoic acid (LTA), that promote an inflammatory response in the gum tissue. This inflammation can cause an enlargement of the gingiva and subsequent formation. Early plaque in health consists of a relatively simple bacterial community dominated by Gram-positive cocci and rods. As plaque matures, and gingivitis develops, the communities become increasingly complex with higher proportions of Gram-negative rods, fusiforms, filaments, spirilla and spirochetes. Later experimental gingivitis studies, using culture, provided more information regarding the specific bacterial species present in plaque. Taxa associated with gingivitis included Fusobacterium nucleatum subsp. polymorphum, Lachnospiraceae [G-2] sp. HOT100, Lautropia sp. HOTA94, and Prevotella oulorum, whilst Rothia dentocariosa was associated with periodontal health.[6] Further study of these taxa is warranted and may lead to new therapeutic approaches to prevent periodontal disease.


Gingivitis is a category of periodontal disease where there is no loss of bone but there is presence of inflammation and bleeding.

Each tooth is divided into four gingival units (mesial, distal, buccal, and lingual) and given a score from 0-3 based on the gingival index. The four scores are then averaged to give each tooth a single score.


Current research shows that activity levels of the following enzymes in saliva samples are associated with periodontal destruction: asparatate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP), and acid phosphatase (ACP). Therefore these enzyme biomarkers may be used to aid in the diagnosis and treatment of gingivitis and periodontitis.





  1. Dental plaque-induced gingival diseases.
    1. Gingivitis associated with plaque only
    2. Gingival diseases modified by systemic factors
    3. Gingival diseases modified by medications
    4. Gingival diseases modified by malnutrition
  2. Non-plaque-induced gingival lesions
    1. Gingival diseases of specific bacterial origin
    2. Gingival diseases of viral origin
    3. Gingival diseases of fungal origin
    4. Gingival diseases of genetic origin
    5. Gingival manifestations of systemic conditions
    6. Traumatic lesions
    7. Foreign body reactions
    8. Not otherwise specified


Gingivitis can be prevented through regular oral hygiene that includes daily brushing and flossing.[8] Hydrogen peroxide, saline, alcohol or chlorhexidine mouth washes may also be employed. In a 2004 clinical study, the beneficial effect of hydrogen peroxide on gingivitis has been highlighted.[9]

Rigorous plaque control programs along with periodontal scaling and curettage also have proved to be helpful, although according to the American Dental Association, periodontal scaling and root planing are considered as a treatment for periodontal disease, not as a preventive treatment for periodontal disease.[10] In a 1997 review of effectiveness data, the U.S. Food and Drug Administration (FDA) found clear evidence showing that toothpaste containing triclosan was effective in preventing gingivitis.[11]


File:Gum paint.jpg


Powered toothbrushes work better than manual toothbrushes in improving the disease.[12]

The active ingredients approved by the American Dental Association that “reduce plaque and demonstrate effective reduction of gingival inflammation over a period of time” are triclosan, chlorhexidine digluconate, and a combination of thymol, menthol, eucalyptol and methyl salicylate. These ingredients are found in toothpaste and mouthwash. Hydrogen peroxide was long considered a suitable over-the-counter agent to treat gingivitis. There has been evidence to show the positive effect on controlling gingivitis in short-term use. A study indicates the fluoridated hydrogen peroxide-based mouth rinse can remove teeth stain and reduce gingivitis.

Mouthwashes with essential oils are also useful.[13]

The bacteria that causes gingivitis can be controlled by using an oral irrigator daily with a mouthwash containing an antibiotic. Either amoxicillin, cephalexin, or minocycline in 16 ounces of a non-alcoholic fluoride mouthwash is an effective mixture.[14]

Overall, intensive oral hygiene care has been shown to improve gingival health in individuals with well-controlled type 2 diabetes.[15] Periodontal destruction is also slowed down due to the extensive oral care. Intensive oral hygiene care (oral health education plus supra-gingival scaling) without any periodontal therapy improves gingival health, and may prevent progression of gingivitis in well-controlled diabetes.


See also



  2. "Parameter on Plaque-Induced Gingivitis". Journal of Periodontology 71 (5 Suppl): 851–2. 2000. PMID 10875689. doi:10.1902/jop.2000.71.5-S.851. 
  3. Ammons, WF; Schectman, LR; Page, RC (1972). "Host tissue response in chronic periodontal disease. 1. The normal periodontium and clinical manifestations of dental and periodontal disease in the marmoset". Journal of periodontal research 7 (2): 131–43. PMID 4272039. doi:10.1111/j.1600-0765.1972.tb00638.x. 
  4. Page, RC; Schroeder, HE (1976). "Pathogenesis of inflammatory periodontal disease. A summary of current work". Laboratory investigation; a journal of technical methods and pathology 34 (3): 235–49. PMID 765622. 
  5. Research, Science and Therapy Committee of the American Academy of Periodontology (2001). "Treatment of Plaque-Induced Gingivitis, Chronic Periodontitis, and Other Clinical Conditions". Journal of Periodontology 72 (12): 1790–1800. PMID 11811516. doi:10.1902/jop.2001.72.12.1790. 
  6. Kistler, James O.; Booth, Veronica; Bradshaw, David J.; Wade, William G.; Glogauer, Michael (14 August 2013). "Bacterial Community Development in Experimental Gingivitis". PLoS ONE 8 (8): e71227. doi:10.1371/journal.pone.0071227. 
  7. Armitage, Gary C. (1999). "Development of a Classification System for Periodontal Diseases and Conditions" (PDF). Annals of Periodontology 4 (1): 1–6. PMID 10863370. doi:10.1902/annals.1999.4.1.1. 
  8. Sambunjak, D.; Nickerson, J. W.; Poklepovic, T.; Johnson, T. M.; Imai, P.; Tugwell, P.; Worthington, H. V. (2011). Johnson, Trevor M, ed. "Flossing for the management of periodontal diseases and dental caries in adults". The Cochrane Library. doi:10.1002/14651858.CD008829.pub2. 
  9. Hasturk, Hatice; Nunn, Martha; Warbington, Martha; Van Dyke, Thomas E. (2004). "Efficacy of a Fluoridated Hydrogen Peroxide-Based Mouthrinse for the Treatment of Gingivitis: A Randomized Clinical Trial". Journal of Periodontology 75 (1): 57–65. PMID 15025217. doi:10.1902/jop.2004.75.1.57. 
  10. American Dental Hygienists’ Association Position Paper on the Oral Prophylaxis, Approved by the ADHA Board of Trustees April 29, 1998
  11. FDA Triclosan: What Consumers Should Know Accessed 2010-08-12
  12. Podgorsak, EB.; Pike, GB.; Olivier, A.; Pla, M.; Souhami, L. (Mar 1989). "Radiosurgery with high energy photon beams: a comparison among techniques.". Int J Radiat Oncol Biol Phys 16 (3): 857–65. PMID 2493438. 
  13. Stoeken, Judith E.; Paraskevas, Spiros; Van Der Weijden, Godefridus A. (2007). "The Long-Term Effect of a Mouthrinse Containing Essential Oils on Dental Plaque and Gingivitis: A Systematic Review". Journal of Periodontology 78 (7): 1218–28. PMID 17608576. doi:10.1902/jop.2007.060269. 
  14. WebMD

External links