Gingivitis is an inflammatory process limited to the mucosal epithelial tissue surrounding the cervical portion of the teeth and the alveolar processes. Gingivitis has been classified by clinical appearance (eg, ulcerative, hemorrhagic, necrotizing, purulent), etiology (eg, drug-induced, hormonal, nutritional, infectious, plaque-induced), and duration (acute, chronic). The most common type of gingivitis is a chronic form induced by plaque. Acute necrotizing ulcerative gingivitis (ANUG, ie, trench mouth) is an acute infectious gingivitis.

• trench mouth

You may have heard the adage "To keep your teeth, take care of your gums." That's good advice.

Gingivitis is one of the most common forms of gum (periodontal) disease. Gingivitis affects the tissues that surround and support your teeth.

The cause is bacteria that irritate your gums, leading to swelling and bleeding. Bacteria on your teeth - along with minerals in your saliva - form tartar (calculus), providing an environment for additional bacteria to accumulate and irritate your gums. Left unchecked, gingivitis can lead to a more serious form of gum disease called periodontitis. This long-term infection can eventually result in loss of your teeth.

Thorough daily brushing, regular flossing and frequent professional cleaning reduce your chances of developing serious gingivitis.

Signs and symptoms

Gum disease generally doesn't hurt. You may have it for years before you feel discomfort.

Don't wait until you feel the pain. Look for these telltale signs of gingivitis:

• Tender, swollen or bleeding gums, particularly when you brush your teeth

• A change in your gums' color from pink to dusky red

Causes

Gingivitis is caused by plaque, a sticky, colorless film of bacteria that coats your teeth. If allowed to harden (calcify), the film turns into white-colored tartar (calculus) that darkens with time.

If plaque and tartar build up, they can irritate the gingiva, the part of your gum around the base of your teeth. This buildup creates pockets of bacteria between your gums and your teeth, and can result in gums that become inflamed and bleed easily.

Risk factors

Everyone's susceptible to gingivitis, and the most common contributing factor is a long-standing lack of attention to proper oral hygiene. But other factors also can increase your risk:

• Heredity. Bacteria that lead to gingivitis are more harmful to some people's gums than to others. Those who are susceptible have a hereditary predisposition to gum disease.

• Medications. Some medications reduce saliva production, causing a dry mouth. Without the cleansing effect of saliva, plaque and tartar can build up more easily. This buildup also increases your risk of tooth decay. Hundreds of prescription and over-the-counter antidepressants and cold remedies contain ingredients that decrease your body's production of saliva. Consumption of alcohol also can decrease saliva production.

• Tobacco use. Smoking slows your gums' ability to heal themselves and to replace tissue destroyed by bacteria. Chewing tobacco and snuff can cause swollen, bleeding gums.

• Diabetes. People with uncontrolled or poorly controlled diabetes are more susceptible to gum disease. Diabetes may result in a thickening of your blood vessels, making them less able to carry nutrients to your gum tissue and to remove wastes. This can leave your gums less healthy and more prone to infection.

• Pregnancy. Hormone changes during pregnancy make your gums more susceptible to the damaging effects of plaque.

• Decreased immunity. Illness can weaken your immune system. This makes you prone to infection, which can lead to gum disease.

• Cold

• Nicotine dependence

If you're at increased risk of gingivitis, daily removal of plaque is particularly essential. You may also need more-frequent professional cleanings. Ask your dentist for recommendations.

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