Penam Periodontics - Evidence based Personalized Periodontics


Gingivitis is non-destructive inflammation of the gum or gingiva. The most common form of gingivitis is a response to bacterial plaque growing on your tooth surfaces. This is often called plaque-induced gingivitis. Gingivitis can be reversed by removing the dental plaque. This usually occurs by a dental professional scaling and cleaning of your teeth and with good home oral hygiene procedures.

However in the absence of treatment, or if not properly controlled, gingivitis can progress to periodontitis in between 20%-50% of the population depending upon your racial group. Periodontitis is where the inflammation results in tissue destruction and bone resorption, which can ultimately lead to tooth loss. Most people with gingivitis do not progress to periodontitis, but periodontitis is always preceded by gingivitis.

Signs and symptoms

The symptoms of gingivitis are simply the signs of inflammation in the gum or gingiva and these are:

  • 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 the development of gingivitis are:

  • Poor oral hygiene;
  • Lower dental care utilization;
  • Lower socio-economic status;
  • Poor education;
  • Older age;
  • Smoking;
  • As yet unknown genetic factors
Aetiology or Cause

The aetiology, or cause, of plaque-induced gingivitis is the prolonged presence of bacterial plaque. The bacterial plaque accumulates on and between the teeth, along the gum line and induces inflammation within the gum. Gingivitis occurs more frequently if crevices or irregularities within the teeth or the fillings, retained calculus (tartar) are present. Failure to clean the teeth is the principle problem leading to the development of gingivitis. Removable partial dentures, bridges or implant crowns which are not properly cleaned can also increase the risk of development of gingivitis.

The bacteria within the plaque produce chemicals, such as enzymes and toxins that induce a host inflammatory response in the gum tissue. The plaque must be present on the teeth for several days before gingivitis will develop. The early plaque consists of gram positive cocci and does not induce gingivitis. The greater the time the plaque is on your teeth, the greater the number of bacteria that are capable of inducing inflammation occur. It has been shown that cleaning twice per day is better than once, but clean more than twice does not additionally improve the control of gingivitis.


Gingivitis can be prevented through regular good oral hygiene that includes daily brushing and cleaning between the teeth. Cleaning between the teeth is a much neglected part of the oral hygiene regimen of many people. There are 4 methods of cleaning between the teeth:

  • Interproximal brushing;
  • Flossing;
  • Water or oral irrigators;
  • Toothpicks.

The most effective methods is interproximal brushing. Dental floss with a built-in brush section would be preferable to the normal thin flosses.

Mouthwashes provide an additional way of reducing the plaque. However patients with excellent plaque control are not likely to require to use mouthwash as it provides no addition benefit to their regimens. However for those patients with less effective oral hygiene the research shows that they may benefit from their use.


The basis of treatment of gingivitis is the removal of the aetiological (causative) agents, the plaque. Therapy is aimed at the reduction of oral bacteria, in particular the more mature plaque that has most of the inflammation associated bacteria within it. The factors suggested in the prevention section above are also used to treat gingivitis.

In our practice we will teach you how to brush properly and advised you to brush twice daily for ~two minutes with a toothpaste that contains fluoride. We will also show you how to use interproximal brushes and floss properly. We will assist you in choosing the best oral hygiene aids for you.

If you are one of the 40% of the population that develop calculus (tartar) you will realize that oral hygiene methods will not remove this material from your teeth. Calculus (tartar) really can only be removed by a dentist or dental hygienist using hand, sonic or ultrasonic instruments.

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