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Healthy gums help keep your teeth anchored to your jaw and create a seal that prevents damaging bacteria from getting under the gumline and destroying supportive connective tissue and bone. But when bacteria and its harmful byproducts linger on teeth, it can cause a condition called gingivitis.
Gingivitis is a periodontal dental disease that can lead to gum infection. If left untreated, inflamed gums might pull away from teeth, creating pockets that give bacteria easy access to your teeth and beyond.
The good news is gingivitis is treatable if it’s caught early. Here’s what you need to know about the disease, who’s at risk, the treatment, prevention and how to keep your mouth healthy.
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In a healthy mouth, the microbiome, or a collection of bacteria and other germs (some of which are beneficial), “are in balance and live in harmony,” explains Kami Hoss, D.D.S, a dentist in Southern California and author of If Your Mouth Could Talk. “But when there’s an imbalance in that microbial community, the ‘bad’ microbes can produce waste products that can damage teeth and gums,” he says. “Gingivitis occurs when bacteria, or their byproducts, lead to gum inflammation or infection.”
Roughly half of all adults have some form of periodontal disease such as gingivitis, according to the most recent data from the Centers For Disease Control and Prevention (CDC), and other estimates put that number even higher[1].
So, how can you tell if you have this common condition? “It may be difficult or impossible for a patient to know … which is why it is so important for everyone to visit an oral health professional on a regular basis, preferably twice a year,” says Chris Richardson, D.M.D. a dentist based in Richmond, Virginia, and president of the American Academy of Periodontology.
In between appointments, look for clues. While healthy gums are firm and pink, gums with gingivitis may be:
Gingivitis can also cause persistent bad breath, thanks to those inflamed gums that hide hard-to-remove plaque and hardened plaque called tartar.
Plaque often leads to gingivitis, according to Johns Hopkins Medicine, especially where the gum and tooth meet.
Your mouth naturally produces plaque—a sticky, nearly invisible film that coats teeth—and if you regularly remove it with brushing and flossing, it typically doesn’t cause problems, according to the American Academy of Periodontology (AAP). But plaque contains bacteria that releases acids damaging to gums, notes the American Dental Association (ADA).
When this bacteria and its byproducts build up and harden on teeth because of poor dental hygiene, they can inflame and irritate the gums, leading to gingivitis. Tartar needs to be removed by a dental professional.
While everyone has plaque, some have risk factors that make them more prone to it than others. In addition to improper or irregular brushing and flossing, some factors that can predispose you to gingivitis are:
Medications: Certain anticonvulsants used to treat seizures, calcium channel blockers that combat high blood pressure and immunosuppressants used to prevent organ rejection in transplant patients can cause an overgrowth of gum tissue, or gingival hyperplasia. That excess tissue can grow so aggressively it covers the crowns of teeth, making it hard to fully remove gum-damaging plaque.
Other medications—in particular, antihistamines to control allergies, blood pressure medicine and certain antidepressants—can reduce the amount of plaque-cleansing saliva the mouth produces.
Tobacco smoke: Smokers tend to have more periodontal disease than nonsmokers[2]. “Tobacco can decimate the mouth’s ‘good’ bacteria, which keep the ‘bad’ ones in check,” says Dr. Hoss. “Smoking can also weaken the body’s immune system, reducing its ability to fight gum infections.”
Diabetes: Periodontal disease is two-to-three times more common in people with diabetes than in those without[3]. Diabetes initiates an inflammatory response in the body, including in the gums, and many medications used to treat diabetes can promote dry mouth.
Diabetes also creates changes in your blood vessels that can ultimately weaken gums and the underlying bony structures of teeth, says Cedars Sinai.
Pregnancy: Up to 75% of pregnant women have gingivitis when they’re expecting, according to the CDC[4]. The hormones estrogen and progesterone, which surge during pregnancy, are likely to blame. These hormones increase blood flow to the gums, making them more sensitive to irritants like plaque.
Age: There’s a lot of wear and tear on teeth and gums as you age. Almost half of adults over 30 have some periodontal disease, notes the CDC. That number jumps to 70% by age 65[5].
Poor nutrition: Without an adequate supply of vitamins and minerals, it’s hard for your immune system to fight infections like gingivitis. Low levels of certain vitamins, including vitamins C, D and a variety of the B vitamins, have been associated with periodontal disease.
Genes: While studies are conflicting, some research estimates that 30% to 50% of periodontal disease is inherited, according to findings in the Journal of Dental Research[6].
Gender: More than half of men have gum disease versus roughly 38% of women, notes the AAP[7]. Men aren’t more susceptible to gum disease, says Dr. Richardson. “But statistically, men report visiting an oral health specialist less frequently than women, which may lead to men having more cases of gum disease.”
Braces: Braces (as well as ill-fitting dentures and bridges) make it difficult to floss and brush thoroughly. Research shows that people with fixed orthodontic appliances like braces have more gum inflammation, recession and visible plaque after orthodontic treatment than before.
If gingivitis progresses into more serious periodontal disease, the gums may feel tender and pull away from the teeth instead of wrapping snugly around them. This loosening of the gums allows bacteria to burrow deeper, destroying tissue and bone and leading to tooth loss.
But that may not just affect your gums.
“The oral microbes or their toxins can gain access into the bloodstream through bleeding gums, and then they can travel anywhere in the body causing a local infection or an inflammatory response,” says Dr. Hoss. “For example, they can travel to the heart, lungs, brain, joints or to an unborn baby.”
Gingivitis is a common condition that may be reversible with the right care. If it goes untreated to the point of more serious periodontal disease, though, the following risks may be associated:
Cardiovascular disease: People with periodontal disease are two-to-three times more likely to have a heart attack or stroke than those with healthy gums, according to Harvard Health[8].
Respiratory infections: People with untreated periodontal disease can breathe in the bacteria, acids and toxins lurking in their gums, which can then settle in the lungs and cause respiratory problems—everything from pneumonia to chronic obstructive pulmonary disease (COPD).
Diabetes: Diabetes can predispose you to periodontal disease—and vice versa. People with uncontrolled periodontal disease—probably because of the way inflammation acts on blood sugar regulation—also have a higher risk of diabetes. “Interestingly, there have been studies that have demonstrated improved home care can improve diabetic metrics, such as decreased blood glucose [blood sugar],” notes Dr. Richardson.
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Impotence: Thanks to the impact chronic inflammation can have on blood vessels, men with periodontal disease are more likely than men without it to develop impotence.
Preterm birth: Having periodontitis (a severe form of gum disease that leads to tooth loss) can increase a person’s chance of having a preterm birth (before 37 weeks gestation) six-fold, putting their babies at risk for health problems such as low birth weight and digestive and breathing issues, according to research in BMC Pregnancy Childbirth[9]. It’s important to note, however, that while some studies show an association between preterm birth and periodontitis, others don’t.
Cancer: Periodontal disease has been associated with cancer, particularly in men. Research shows that men with gum disease can be 49% more likely than women to develop kidney cancer, 54% more likely to develop pancreatic cancer and 30% more likely to develop blood cancers, notes the AAP[10].
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The main treatment for gingivitis that hasn’t progressed to more severe periodontal disease is good oral hygiene and professional dental cleanings. This includes, per the CDC:
These measures can help control and even reverse gingivitis. But when it progresses into more extensive disease, your dentist may recommend additional treatments, including:
Scaling and root planing: Plaque and tartar are removed from below the gumline and the surface of the tooth root is smoothed, making it harder for plaque to adhere.
Periodontal pocket procedure: A periodontist affixes gum tissue to the tooth, thereby eliminating “pockets.”
Drug treatment: Medications can include antibiotics and mouthwashes that fight bacteria.
Prebiotics: “Prebiotics are ingredients that can feed and promote the beneficial microbes in the mouth while stopping the harmful ones,” notes Dr. Hoss. “One of my favorites is xylitol, found in some oral-care products because it tastes great and it also increases the pH of saliva, which helps the ‘good’ microbes thrive.”
Costs for these procedures/treatments will vary, based on the severity of your disease, where you live and whether you’ll need imaging, such as X-rays.
The best way to prevent gingivitis is to take care of your teeth. That’s why it’s key to brush, floss and regularly see a dental professional for cleanings. Get seen sooner if you notice signs of gingivitis, such as swollen, tender gums that bleed easily.
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Donna Christiano Campisano is a freelance writer specializing in women and children’s health issues. She has written for numerous consumer publications and websites, including Parents, Woman’s Day, Good Housekeeping, Healthline and Verywell Health. She has also served on the staffs of both Glamour and Brides magazines as a researcher and copywriter. In addition to freelance writing, Christiano also works as a staff writer at the University of South Florida’s College of Public Health. She lives in the Tampa area with her family and beagle, Bananas.
Dr. Teresa Yang is a general dentist and dental writer. In today’s managed care and insurance-driven world, she started and developed two practices from scratch where she treated patients for over 30 years. Dr. Yang has served in many capacities with the California Dental Association, including Chair of the Peer Review Council, a program for dispute resolution between patients and dentists. She has lectured extensively on peer review and conflict resolution. Dr. Yang is also a former faculty member and group director at the UCLA School of Dentistry.
